such as congenital hypothyroidism, and genetic disorders, such as Prader–Willi, all may present with hypotonia The hypotonic infant can be identified by low resting tone—the classic “froglike” position with abnormal extension of the limbs —as well as exaggerated head lag when pulled to sit Central hypotonia can be identified when there is excessive “slip-through” at the shoulder girdle when the infant is held in vertical suspension, or when the limbs and head hang low on horizontal suspension While the hypertonic infant is an abnormal neurologic finding and should be referred to a specialist, it rarely presents as an emergency Exceptions include neonatal tetanus and advanced staged kernicterus, with hypertonic extension of the extremities, retrocollis, and opisthotonus NEONATAL INFECTIONS Goals of Treatment Neonatal infection and neonatal sepsis are among the most common diagnoses encountered in the emergency room The immature immune system makes newborns very susceptible to infection resulting in more severe manifestations than older children or adults Neonatal infections often have nonspecific presentations Neonatal sepsis should be included in any differential diagnosis in a symptomatic neonate Rapid evaluation and management of acute deterioration is the initial goal of therapy Obtaining the necessary cultures and diagnostic testing and coverage with broad-spectrum antibiotics is the main priority Symptomatic neonates should be admitted for close observation due to the likelihood of progression Treatment is then tailored to the specific pathogen once it has been identified Treatment in the ED is aimed at cardiorespiratory stabilization and rapid initiation of antibiotic therapy to prevent acute deterioration KEY POINTS