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This is an ill-appearing  who presents with lethargy. Differential includes sepsis, congenital heart disease, hypovolemia and hypoxemic states, endocrine emergencies like CAH or thyroiditis, trauma, inborn errors of metabolism, seizures, electrolyte derangements, or intestinal catastrophe. Given this undifferentiated sick neonate, will work up broadly, empiric broad-spectrum antibiotics , trial of 10cc/kg fluid bolus, resuscitative measures and will consider early airway intervention.

Pearls: For a sick kid use THE MISFITS:

Trauma: consider FAST and CTH

– consider vitamin K and Ca if bleeding

Heart disease, hypovolemia, hypoxia

Endocrine (CAH, thyrotoxicosis)

Metabolic – lytes

Inborn errors


Formula mishaps

Intestinal catastrophes (volvulus, intuss, NEC)



from natedotphrase.com

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