Evaluation and Management of the Critically Ill Neonate in the Emergency Department

The care of a critically ill neonate in the emergency department setting presents a special challenge for practitioners who do not routinely encounter compromised neonates. This review will provide guidelines for the initial stabilization of these infants as well as identify differential diagnoses that should be considered. As with any critically ill patient, achieving physiologic stability of the neonate is the first priority. However, in addition to maintaining the airway, breathing, and circulation, thermoneutrality must be achieved for a successful outcome. Obtaining the history and initiating diagnostic evaluations should occur during or shortly after the course of stabilization to promptly initiate disease-specific therapies. The mnemonic “NEO SECRETS” may help focus the care and promote early identification of the cause of the infant's deterioration.