The Decompensated Neonate in the First Week of Life

The first week of life can be a critical period in which previously subclinical disorders may manifest, causing significant illness. Newborn infants also have different baseline vitals and laboratory parameters, which complicate the initial evaluation of infants. Rapid identification of sick neonates, stabilization, and directed evaluation are keys to minimizing long-term morbidity and mortality. This review targets 5 conditions that present in the first week of life: neonatal sepsis, critical congenital heart disease, inborn errors of metabolism, congenital adrenal hyperplasia, and hemorrhagic disease of the newborn. The primary focus is on key findings, initial evaluation, and immediate treatment in the emergency department where these infants often present after discharge from the newborn nursery.