Surgical conditions in neonates can present with wide variety of symptoms, including respiratory distress, fever, lethargy, weight loss, and poor feeding. Progression of symptoms can be helpful in decision making but may not be easily or accurately elicited from an infant or poorly observant parent.
The surgically correctable causes of respiratory distress in newborns are less frequent and include choanal atresia, micrognathia (Pierre Robin syndrome), laryngomalacia, tracheomalacia, tracheoesophageal fistula, and vascular rings. Most of these anomalies are identified in the newborn nursery, but in the emergency department these possibilities should be entertained in any infant with respiratory distress. In the neonate with abdominal symptoms, the most common diagnoses include necrotizing enterocolitis and congenital anomalies such as malrotation with midgut volvulus, duplication, gastroschisis, and omphalocele. Pyloric stenosis typically presents between 2 and 6 months of age. Incarcerated inguinal hernias and intussusception are most common after 2 months of age. Incarcerated hernia and intussusception account for most of abdominal surgical emergencies in the 2-month-old to 1-year-old group; the former decreases in incidence after 1 year of age.
The diagnosis of abdominal emergencies is challenging in the emergency department. A systematic approach helps to minimize missed diagnoses. The most common signs are irritability and crying, followed by poor feeding, vomiting, constipation, and abdominal distention. Prudent and directed use of laboratory and imaging studies will minimize misdiagnosis. The early involvement of a surgeon in the care of pediatric patients who have significant abdominal symptoms is recommended. 1 J,6
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