Neonatal Care in the Emergency Department
Introduction
Neonates-particularly ex‑premature infants and recent NICU graduates-require a cautious, systematic approach in the ED. Presentations are often subtle yet potentially life‑threatening (sepsis, respiratory failure, hypoglycaemia, surgical complications).
Care should prioritise rapid stabilisation using newborn life‑support principles, targeted investigation for serious pathology, early senior paediatric/neonatal involvement and clear disposition planning.
Key definitions and orienting concepts
- Corrected (adjusted) gestational age: age from expected term (40 weeks). Use corrected age when assessing development and physiological expectations in ex‑preterm infants.
- NICU graduate: infant recently discharged from neonatal intensive or high‑dependency care; may have ongoing oxygen, tube feeding, recent surgery or multi‑drug colonisation.
- Vulnerable cohorts: ex‑preterms (especially with chronic lung disease or home oxygen), infants with gastrostomies/NG tubes, recent post‑operative neonates, and those receiving RSV prophylaxis (palivizumab/nirsevimab) (GOV.UK).
Initial approach and priorities
Follow the airway-breathing-circulation (ABC) paradigm and Resuscitation Council UK Newborn Life Support (NLS) algorithms for all unstable neonates (Resuscitation Council UK). Key actions:
- Provide immediate thermal care to avoid hypothermia.
- Apply neonatal airway and ventilation strategies; use gestation‑based initial oxygen concentration and titrate to recommended neonatal saturation targets (RCUK NLS).