The Crashing Neonate

An increasing incidence of newborn emergency department visits in the United States has been documented; this may be due to a higher number of home births and hospital policies directing earlier discharge of newborns from nurseries. Although many of these visits are for benign conditions, it is imperative that the emergency physician know how to manage a critically ill neonate (a newborn in the first 28 days of life). The mnemonic, THE MISFITS, provides a method for remembering many of the serious conditions that present acutely in the neonatal period: trauma (accidental trauma and child abuse), heart disease (structural and nonstructural) and hypovolemia, endocrinopathies, metabolic abnormalities (electrolyte imbalances), inborn errors of metabolism, sepsis, formula mishaps (under- or overdilution), intestinal catastrophes (e.g., necrotizing enterocolitis and midgut volvulus), toxic exposures, and seizures. This chapter provides the essential clinical information for several of these conditions.