The evaluation and appropriate management of the critically ill neonate requires knowledge of the physiologic changes and life-threatening pathologies that may present during this time period. A broad systematic approach to evaluating the neonate is necessary to provide a comprehensive yet specific differential diagnosis for a presenting complaint or symptom. Efficient recognition and prompt management of illness in the neonatal period may be life saving. Recently, it has become more important for the emergency department physician to be familiar with the neonate because of early discharge policies. This review provides a systematic approach to the recognition, emergency stabilization, and management of the more common newborn emergencies.