INTRODUCTION AND EPIDEMIOLOGY
Neonates are infants ≤1 month old, or preterm infants within 30 days of their term due date. Symptoms that precipitate ED visits in neonates are often vague and nonspecific. Signs are usually subtle and may not point to a specific diagnosis. For example, respiratory distress can be caused by pulmonary or cardiac disease, generalized sepsis, abdominal pathology, or metabolic disorders. Many visits occur because of caregiver concerns about normal variants of newborn vegetative functions. Such concerns must be distinguished from potentially life-threatening congenital and acquired conditions that can present in the first month of life. This chapter reviews normal neonatal vegetative patterns, life-threatening neonatal emergencies, and common neonatal problems.
NORMAL NEONATAL VEGETATIVE FUNCTIONS
In the first few weeks of life, expect variation in times between feedings, but by the end of the first month, the vast majority of newborns establish a regular feeding schedule. Most healthy, bottle-fed infants eat 2 to 4 ounces every 2 to 4 hours (six to nine feedings in 24 hours) by the end of the first week of life; breastfed infants prefer shorter intervals—feeding every 1 to 3 hours. Intake is adequate if the neonate gains weight appropriately and appears content between feedings. Feedings are progressing well if the infant is no longer losing weight by 5 to 7 days of age and is gaining weight by 12 to 14 days of age.
Weigh neonates completely undressed. Normal newborns may lose up to 12% of their birth weight during the first 3 to 7 days of life, with earlier and slightly more accentuated weight loss in exclusively breastfed newborns. A weight loss of up to 10% is accepTable if the infant's examination, stooling, and voiding frequency and behavior are normal. On average, infants gain between 20 and 30 grams per day in the first 3 months of life and between 15 and 20 grams per day for the next several months.
The number, color, and consistency of bowel movements can vary greatly in the same infant and between infants, regardless of diet or environment (Table 114-1).
TABLE 114-1Stool Frequency Ranges in Neonates and Infants |Favorite Table|Download (.pdf) TABLE 114-1 Stool Frequency Ranges in Neonates and Infants
|Authors ||Number ||Age ||Feed ||Mean Number of Stools/d ||Range (number of stools/d) |
|Hyams et al. (1995)1 ||283 ||1 mo ||Breastfed ||4.2 ||0.3–9.6 |
|Cow's milk formula ||2.3 ||0.4–6.7 |
|Cow's milk formula with iron ||2.1 ||0.9–4.1 |
|Soy formula ||2.2 ||0.7–4.1 |
|Extensively hydrolyzed cow's milk formula ||3.6 ||1.1–8.6 |
|Tham et al. (1996)2 ||140 ||0–24 mo ||Breastfed ||4.4 ||0.3–8.0 |
|Formula fed ||1.6 ||0.6–3.9 |
An excessive intake of human milk or maternal use of laxatives increases the water content ...