Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci, a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls.

Anthony introduces NEO SECRETS, a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, and key treatment considerations.

NEO SECRETS Breakdown:

• N – Inborn errors of metabolism

• E – Electrolyte abnormalities

• O – Overdose or toxic exposure

• S – Sepsis (the leading cause of neonatal mortality)

• E – Endocrine crisis (e.g., hypoglycemia, adrenal insufficiency)

• C – Cardiac conditions (cyanotic vs. acyanotic presentations)

• R – Recipe or formula mishaps (e.g., dilution errors leading to hyponatremia)

• E – Enteric emergencies (e.g., malrotation with volvulus, gastroenteritis)

• T – Trauma, including accidental and non-accidental injuries

• S – Seizures (often subtle and hard to recognize in neonates)

Key Takeaways:

• Neonates are not small adults or even small pediatric patients—they are physiologically distinct and highly vulnerable.

• Early identification of sepsis, cardiac issues, and metabolic errors can save lives.

• Paramedics should rely on strong assessment skills, detailed history-taking, and high suspicion for uncommon causes.

• Videos, glucose checks, pre-ductal saturations, and detailed caregiver interviews are essential field tools.

• Understanding neonatal physiology, presentation timelines, and risk factors improves both confidence and outcomes.

Why Listen:

If you've ever felt unprepared when faced with a neonatal call, this episode provides a clear, practical, and memorable guide to the top threats to neonates—and how to recognize and respond to them in the field.