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Useful Info

THE MISFITS

Neurologic emergencies

Recognizing a neurologic insult in neonates may be difficult. The clinical

symptoms may be nonspecific. The history may reveal only a change in feeding

pattern or subtle behavioral changes. A useful mnemonic to recall the broad

differential diagnosis of a neonate with altered mental status, ‘‘THE MISFITS,’’

is outlined in Box Keeping this mnemonic in mind as well as a high index of

suspicion during the initial history and physical examination (non) will help

guide the evaluation and management

Causes of altered mental status in a neonate: THE MISFITS

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

Source= http://hsc.unm.edu/emermed/ped/physicians/residents/articles/Newborn%20Emergencies%20The%20First%2030%20Days%20of%20Life.pdf

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