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The global increase in neonatal visits to Pediatric Emergency Departments (PEDs) underscores the need to better understand the factors driving these visits and their implications. The often vague and nonspecific symptoms of neonates pose significant challenges for clinicians and caregivers in determining the appropriate level of care, impacting the frequency of return visits and overall effectiveness of discharge education. This study aims to compile the most common chief complaints of neonates in the PED and analyze their association with admission rates and final ED diagnoses to inform educational interventions for caregivers and medical personnel. This was a retrospective review of data from medical records from neonatal (≤30 days of life) presentations to the PED at a quaternary care medical center in Portland, Oregon, USA from January 2012 to December 2022. 3175 patient encounters were identified, of which one-third (38 %) were admitted to the hospital. Certain complaints had higher admission rates than the average: temperature instability (71 % for "fever" and 89 % for "hypothermia"), breast concerns (68 %), abnormal lab results (63 %), "seizures" (53 %), and cardiac concerns (54 %). Notably, neonates presented on DOL 0 and DOL 1 had elevated admission rates of 77 % and 66 %, respectively. This study identified specific complaints that were most likely to result in hospital admissions and return visits to the ED. This can guide targeted educational interventions for caregivers and ED providers and refinement of triage protocols to ensure that neonates receive the most appropriate and efficient care. [ABSTRACT FROM AUTHOR]