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Symptoms in neonates are usually vague and nonspecific. Signs are usually subtle and, even when recognized, may not be helpful in pinpointing a diagnosis. For example, respiratory distress may be due either to pulmonary or cardiac disease, generalized sepsis, abdominal pathology, or metabolic derangements. The majority of neonatal visits to the ED are nonurgent and related to caretaker inexperience with normal neonatal development. However, a myriad of potentially life-threatening congenital and acquired conditions can present in the first month of life.

A review of presenting complaints in our pediatric ED, a tertiary-care referral center, over a 12-month period revealed that 2100 out of a total of >39,000 visits were for infants <3 months of age and exemplified the spectrum of issues most likely to be seen by the emergency physician (Table 111-1). Complaints in neonates are usually not single but are often symptom complexes. Such symptom complexes reflect the nonspecific nature of signs and symptoms in neonates and the overlapping presentation of many diseases of diverse etiology.

Table 111-1 Common Pediatric Emergency Presenting Complaints

General principles of normal infant and child development are discussed in Chapter e109.1, Assessment of the Child in the Emergency Department: A Practical Application of Normal Child Development. However, some of the important principles applicable to neonates are reviewed here. Many visits are initiated because of caregiver concerns related to normal variants of newborn vegetative function, namely feeding patterns, weight gain, stool frequency, color, and consistency, skin rashes, and breathing patterns. Routine early discharge from the newborn nursery may increase the number of ED visits for issues that previously would have been recognized and addressed before discharge. This trend requires the emergency physician to have a more thorough knowledge of neonatal issues.

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