Differential Diagnosis for Newborn with Sleeping and Feeding Difficulties, Vomiting, Diarrhea, Sweating, Tachypnea, and Sneezing

• Single Most Likely Diagnosis
  • Neonatal Abstinence Syndrome (NAS): This condition occurs in newborns exposed to opioids or other substances in utero, leading to withdrawal symptoms after birth, which can include irritability, feeding difficulties, vomiting, diarrhea, sweating, and respiratory distress.
• Other Likely Diagnoses
  • Sepsis: Newborns are susceptible to infections, and symptoms like feeding difficulties, vomiting, diarrhea, and respiratory distress can be indicative of sepsis, especially if there's a history of maternal infection or prolonged rupture of membranes.
  • Congenital Heart Disease: Some forms of congenital heart disease can present with feeding difficulties, sweating, and respiratory symptoms like tachypnea due to increased energy expenditure and potential heart failure.
  • Gastroesophageal Reflux Disease (GERD): While more common in older infants, GERD can cause vomiting, feeding difficulties, and irritability in newborns.
• Do Not Miss Diagnoses
  • Congenital Diaphragmatic Hernia: This condition can cause severe respiratory distress and may present with feeding difficulties due to associated gastrointestinal anomalies. It's critical to diagnose promptly as it requires surgical intervention.
  • Necrotizing Enterocolitis: Although more common in premature infants, this condition can occur in term newborns and presents with abdominal distension, vomiting, and diarrhea, potentially leading to severe complications if not recognized early.
  • Hypoglycemia: Newborns, especially those with risk factors like maternal diabetes, can present with nonspecific symptoms such as jitteriness, sweating, and feeding difficulties, which can progress to more severe neurological symptoms if not treated.
• Rare Diagnoses
  • Congenital Adrenal Hyperplasia: This group of genetic disorders can lead to adrenal insufficiency, presenting with vomiting, diarrhea, and potentially life-threatening electrolyte imbalances.
  • Intestinal Obstruction: Conditions like pyloric stenosis, intestinal atresias, or meconium ileus can cause vomiting and feeding difficulties, with some forms presenting acutely in the newborn period.
  • Metabolic Disorders: Certain inborn errors of metabolism can present in the newborn period with nonspecific symptoms such as lethargy, feeding difficulties, and vomiting, progressing to severe illness if not identified and managed appropriately.