Neonatal Problems & ALTE

It is important to have a systematic approach to examining neonates as there is naturally a very limited history with no normal baseline and symptoms are often vague and nonspecific.


EM Curriculum: (click to view)


There are few things more fear provoking to Emergency Physicians than the presentation of a sick neonate.

Everything is different; not only in size but also the pathophysiology of disease with some serious conditions presenting uniquely in this group.

Hopefully this module will provide you with a systematic approach to evaluation and management of the very young.

In Leicester GPs hold the contract for performing baby-checks so if mums are discharged within the first 24 hours this will not be performed in hospital and there may be a few days wait until a GP appointment for this can be secured.

As a result for many very young babies presenting to the department it is entirely possible that the ED doctor is the first person to ever examine the child and therefore the opportunity should be taken to perform a thorough assessment.


  • Define ALTE.

  • Take a history from and examine a child presenting with ALTE and propose an appropriate plan for investigation and management.

  • Recall the NLS algorithm.

  • Describe the care of a woman in labour who is about to deliver imminently.

  • Understand the unique physiology of neonates including thermoregulation.


  • Perform a systematic examination of a neonate.

  • Demonstrate resuscitation of the newborn as per NLS/APLS guidelines.

  • Recognise a healthy neonate.

  • Formulate a differential diagnosis for a variety of common presenting complaints.


Complete the following before the face-to-face session:


Duration: 20 mins

Read this guideline from the Royal Children's Hospital Melbourne.


Task 2: Delivery in the ED & Neonatal resuscitation

Duration: 40 mins

This guideline for paramedics gives a useful overview ofhow to assist in a normal delivery and how to manage some common problems that can occur at or shortly after delivery

This video provides a great run through of neonatal resuscitation as per the NLS protocol. A copy of the NLS algorithm can be found in the Additional Resources area of this module.

Task 3: Newborn Examination

Duration: 20 mins

Ready this guide to the Newborn Baby Check by Don't Forget the Bubbles.


Task 4: Neonatal Physiology

Duration: 20 mins

This is a thorough overview of fetal and neonatal physiology and the changes that occur at birth.


Task 5: The Sick Baby

Duration: 28 mins

This podcast discusses the approach to a sick baby under 3 months and features our very own PEM Consultant Dr Rachel Rowlands

#EM3 Content

Lightning Learning:



We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

You are asked to see a 3 day old baby who has developed a rash. It appeared today initially as a couple of spots on his face.
Look at the above picture of a well baby who has presented as parents are concerned about his sore bottom.


Here are some extra resources to review if you want more information:

Newborn examination

This guideline from Queensland is a thorough guide to performing a baby check.

Stanford University Newborn Photo Gallery

A great resource containing hundreds of pictures of both normal and abnormal findings in neonates.

Newborn skin: common rashes

This article from American Family Physician is a very informative reference on common exanthems in neonates with plenty of photos.

Neonatal Life Support

The Neonatal Life Support algorithm.

The following are helpful resources on the assessment and management of sick neonates:



Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: