Pediatric emergency medicine trisk 2458 2458
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discharge. For example, certain congenital anomalies may be life threatening, and
yet may not present until after this transition has been completed and the newborn
has been discharged home. Other perinatally acquired conditions may not present
until days later due to their insidious onset. Additional challenges include subtle
neonatal presentations and more severe symptoms in response to pathogens
because of immature immune function and lack of energy stores. The immune
system is entirely dependent on passive immunity provided from the mother
during pregnancy, leaving the neonate immunocompromised and susceptible to
life-threatening infections. Furthermore, infants have very little in terms of
cardiopulmonary reserve, so that the sick infant can go from well appearing to
critically ill and cardiopulmonary arrest in a short period of time. Finally,
pathogens to which neonates are likely to be exposed during birth include
aggressive bacteria and viruses, including Group B streptococcus (GBS), gramnegatives, and herpes simplex.
Regardless of the etiology of injury or illness, neonates have a very limited
ability to communicate critical changes in health. Infants cannot express
subjective data, and often new parents are unable to identify critical changes in
infant behavior. As such, it is important for the caregiver to gather and interpret
subtle changes in vital signs and the physical examination to avoid catastrophic
injury to the ill newborn.
In this chapter, we will highlight the major differences between neonatal
anatomy and physiology compared to that of older children. We will also provide
clinicians with a concise synopsis of common neonatal disorders that may be
encountered in the ED.
Goals of Treatment
Given the unique challenges of neonatal care, the primary goals of treatment are
twofold: (1) to distinguish early signs of a sick infant from normal newborn
behaviors and (2) to provide timely intervention to prevent permanent injury or
death in the case of an ill neonate.
Clinical Considerations
Clinical Recognition
To assist in the clinical recognition of a sick infant, close attention must be paid to
the vital signs obtained in triage. Subtle changes in vital signs can often be the
only indication of serious illness, and the early detection of these changes can
alert the clinician to intervene prior to the loss of physiologic reserve and
cardiopulmonary collapse.
