CHAPTER 96 ■ NEONATAL EMERGENCIES NICKIE NIFORATOS ANDESCAVAGE, DEENA BERKOWITZ INTRODUCTION AND INITIAL ASSESSMENT Goals of Emergency Care The neonate is in a fragile state of transition to extrauterine life Newborns have limited ability to maintain temperature and glucose and they have limited cardiopulmonary reserves to compensate for dehydration, sepsis, or other stressors Newborns may exhibit apnea, rather than tachypnea, in response to hypoxia They are immunocompromised and are unable to communicate subjective findings Every clinical finding is likely to be more subtle in the neonate than in the older infant Therefore, the goals of emergency care are to triage and treat neonates urgently until serious disease has been ruled out, while maintaining body temperature and serum glucose KEY POINTS Newborns have very little reserve to compensate when acute illnesses occur Tachypnea may be the only presenting sign of congestive heart failure Hypothermia, rather than fever, may be a neonate’s response to sepsis Weight loss is the most sensitive sign of dehydration in the newborn A loss greater than 10% of birth weight during the first 10 to 14 days of life should be thoroughly investigated Careful attention must be paid to maintenance of temperature and glucose in the ED RELATED CHAPTERS