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Abstract

The ill neonate is a frightening entity for most emergency clinicians. Neonates are a rare entity at many nonpediatric emergency departments (EDs), and when they are brought in, it is frequently for minor complaints.² When critically ill infants do present, appropriate newborn resuscitation equipment and consultations are often unavailable.^3,4 Even when a general pediatric consultation is readily available, the experience with ill children may be limited. One study of academic pediatric training programs indicated that only 36% of graduating residents had led a pediatric resuscitation, and a handful had no pediatric advanced life support (PALS) training.⁵ It is easy to understand why the resuscitation of a neonate can be an intimidating and lonely experience for an emergency clinician.

This issue of Pediatric Emergency Medicine Practice will discuss recognition of the causes as well as general and disease-specific means of stabilizing the critically ill neonatal patient. There are many rare diseases that can cause shock in a neonate. This article will concentrate on some of the most common: sepsis/serious bacterial infections (SBIs), including meningitis, bacteremia, and urinary tract infection; malrotation; necrotizing enterocolitis (NEC); ductal-dependant cardiac lesions, including cyanotic congenital heart disease and ductal-dependent obstructive lesions; inborn errors of metabolism (IEMs) that present with significant metabolic derangement in the neonatal period (specifically, urea cycle defects and organic acidemias); salt-wasting types of congenital adrenal hyperplasia (CAH); and nonaccidental trauma (NAT).

Keywords:
pediatric, neonate, critically ill neonate, infant,

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