In general, the signs and symptoms of illness are vague and nonspecific in neonates making the identification of specific diagnoses challenging (Table 67-1). The survival of premature infants has produced a population of children whose corrected gestational age (chronological age since birth in weeks minus the number of weeks of prematurity) makes them, in some ways, similar to neonates. Neonates present to the emergency department with a range of conditions that span from normal to critical.
Table 67-1 Nonspecific Signs and Symptoms of Neonatal Emergencies |Favorite Table|Download (.pdf)
Table 67-1 Nonspecific Signs and Symptoms of Neonatal Emergencies
|Fever or hypothermia|
|Abnormal tone (limp or stiff)|
|Altered mental status (lethargy or irritability)|
|Cyanosis or mottling|
Bottle-fed infants generally take 6 to 9 feedings (2 to 4 oz) in a 24-hours period, with a relatively stable pattern developing by the end of the first month of life. Breast-fed infants generally prefer feedings every 1 to 3 hours. Infants typically lose up to 12% of their birth weight during the first 3 to 7 days of life. After this time, infants are expected to gain about 1 oz/d (20 to 30 grams) during the first 3 months of life. The number, color, and consistency of stool in the same infant changes from day to day and differs among infants. Normal breast-fed infants may go 5 to 7 days without stooling or have 6 to 7 stools per day. Color has no significance unless blood is present or the stool is acholic (ie, white).
A normal respiratory rate for a neonate is from 30 to 60 breaths/min. Periodic breathing (alternating episodes of rapid breathing with brief (< 5 to 10 seconds) pauses in respiration) is usually normal. Normal newborns awaken at variable intervals that can range from about 20 minutes to 6 hours. Neonates and young infants tend to have no differentiation between day and night until approximately 3 months of age.
There are benign to life-threatening causes of prolonged crying in infants (Table 67-2). True inconsolability represents a serious condition in most infants and requires investigation for injury (accidental or inflicted), infection, supraventricular tachycardia (SVT), corneal abrasion, hair tourniquet, hernia or testicular torsion, or abdominal emergency. If, after a thorough emergency department evaluation, a cause for excessive crying has not been identified and the child continues to be inconsolable, admission to the hospital is warranted.
Table 67-2 Conditions Associated with Acute, Unexplained, Excessive Crying in Neonates |Favorite Table|Download (.pdf)
Table 67-2 Conditions Associated with Acute, Unexplained, Excessive Crying in Neonates
|Hair tourniquet (finger, toe, penis)|
|Fracture (nonaccidental trauma)|
|Inborn error of metabolism|
|Acute infection (sepsis, urinary tract infection, meningitis)|
|Congenital heart disease (including supraventricular tachycardia)|
|Abdominal emergency (incarcerated hernia, volvulus, ...|