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 |
