Chapter 116: Neonatal Emergencies and Common Neonatal Problems

INTRODUCTION AND EPIDEMIOLOGY

Neonates, defined as infants ≤1 month old, or preterm infants within 30 days of their term due date, often visit EDs with vague and nonspecific symptoms and signs that may not point to a specific diagnosis. For example, respiratory distress can be caused by pulmonary or cardiac disease, generalized sepsis, abdominal pathology, or metabolic disorders. Many visits occur because of caregiver concerns about normal variants of newborn vegetative functions. Such concerns must be distinguished from potentially life-threatening congenital and acquired conditions that can present in the first month of life. This chapter reviews normal neonatal vegetative patterns, life-threatening neonatal emergencies, and common neonatal problems.

NORMAL NEONATAL VEGETATIVE FUNCTIONS

FEEDING PATTERNS

In the first few weeks of life, expect variation in times between feedings, but by the end of the first month, the vast majority of newborns establish a regular feeding schedule. Most healthy, bottle-fed infants eat 2 to 4 ounces (60–120 mL) every 2 to 4 hours, or six to nine feedings in 24 hours by the end of the first week of life; breastfed infants prefer shorter intervals—feeding every 1 to 3 hours. Intake is adequate if the neonate gains weight appropriately and appears content between feedings. Feedings are progressing well if the infant is no longer losing weight by 5 to 7 days of age and is gaining weight by 10 to 14 days of age.

WEIGHT GAIN

Weigh neonates completely undressed. Normal newborns may lose up to 12% of their birth weight during the first 3 to 7 days of life, with earlier and slightly more accentuated weight loss in exclusively breastfed newborns. A weight loss of up to 10% is acceptable if the infant’s examination, stooling, and voiding frequency and behavior are normal. On average, infants gain between 20 and 30 grams per day in the first 3 months of life and between 15 and 20 grams per day for the next several months.

STOOL PATTERNS

The number, color, and consistency of bowel movements can vary greatly in the same infant and between infants, regardless of diet or environment. The median daily stools vary between types of nutrition (breast milk, formula, or mixed), ranging from 1 to 4.¹ Stooling once a week or eight times per day may be normal if the clinical history and physical examination are also normal. Increased stools may be a result of excessive intake, concentrated or high sugar formula, maternal use of laxatives, malabsorption/enteropathy, or infection. Infrequent stooling may be normal (especially if breastfed) or may be a sign of constipation. Failure to pass meconium in the first 48 hours of life may suggest Hirschsprung’s disease or cystic fibrosis. Stool color has no significance unless it is acholic or bloody. The first stool, which consists of meconium, is usually passed ...