Neonatal Emergencies after Discharge (with case presentations)

The number of neonates presented to Emergency Department (ED) has been increasing. Some neonates discharged from the hospital in apparently good condition develop clinically visible complaints within days or weeks post discharge. The majority of visits of neonates to ED are rather benign, such as jaundice and colic. However, presenting signs of critically ill neonates are often nonspecific. Therefore it is crucial to identify neonates with life-threatening conditions. The initial step should be the immediate cardiopulmonary resuscitation and stabilization of these neonates.

The detailed evaluation of underlying causes and specific management are the following steps. Due to the great variety of causes the mnemonic “THE MISFITS” is used to describe the differential diagnosis of critically ill neonates: T (Trauma/non-accidental trauma), H (Heart disease, congenital/hypovolemia/hypoxia/respiratory complaints), E (Endocrine, congenital adrenal hyperplasia, thyrotoxicosis), M (Metabolic disturbances, hypoglycemia, hyponatremia), I (Inborn errors of metabolism, S (Sepsis), F (Formula dilution or over-concentration), I (Intestinal catastrophes), T Toxins (home remedies), S (Seizures). After cardiopulmonary stabilization in the ED critically ill neonates should be admitted to a neonatal or pediatric intensive care unit for further management.