The Misfits: Causes of Neonatal Distress

Neonates (<28 days of age) are a fragile population that can present in life-threatening distress that requires immediate evaluation and treatment. As such, utilizing a systematic approach can help identify and treat the most common causes of neonatal distress. As more hospital nurseries discharge patients earlier, emergency departments must be ready to evaluate, diagnose, and treat neonatal emergencies. ​

For more information; ACEP "The Misfits"

The Misfits

The Misfits is a useful mnemonic for neurologic changes in the neonate, and can be expanded to neonatal distress in general to aid in a systematic approach to all neonates in distress.  Keep in mind that neurologic changes in the very young may be subtle and difficult to diagnose. 

• T–Trauma (nonaccidental and accidental)
• H–Heart disease and hypovolemia
• E–Endocrine (eg, congenital adrenal hyperplasia and thyrotoxicosis)
• M–Metabolic (electrolyte imbalance)
• I–Inborn errors of metabolism
• S–Sepsis (eg, meningitis, pneumonia, and urinary tract infection)
• F–Formula mishaps (eg, under- or overdilution)
• I–Intestinal catastrophes (eg, volvulus, intussusception, and necrotizing enterocolitis)
• T–Toxins and poisons
• S–Seizures

Intestinal Emergencies

1. Volvulus
2. Intussusception
3. Necrotizing Enterocolitis
4. Incarcerated Hernia
5. Diaphragmatic Hernia