SOME COMMON CONDITIONS IN

NEONATES
By:
Dr Sonali Soumyashree(PT)
Asst prof.
ABSMARI
 CONTENTS TO BE COVERED

 Microcephaly,
 Hearing impairment,
 Squint and convulsions.
 Blindness,
 MICROCEPHALY
 Abnormality in head size &
shape:
 Macrocephaly
 Microcephaly
 Head growth may be affected
by abnormal growth of the
skull bones or alterations in
brain parenchyma,
cerebrospinal fluid or bone
 Microcephaly: occipitofrontal
circumference more than 3
standard deviations
 Types: Primary & Secondary
 Primary
 conditions associated with reduced generation of neurons during neural
development and migration.
 Secondary
 injury or insult to a previously normal brain causing reduction in the number of
dendritic processes and synaptic connections
 Microcephaly is an condition with abnormally small brain, based
on findings on neuroimaging or neuropathology
CAUSES
 PATHOGENESIS

 Genetic & environmental

 Genetic: MCPH1 – MCPH 25:
 Abrogation of any of the
genetic process lead to
microcephaly.
 SYMPTOMS

 A head size significantly

smaller than that of other
children of the same age and
sex.
 Forward sloping forehead
 It is an autosomal recessive phenotype & is associated with reduced
OFC( occipito frontal circumference) since birth, normal cerebral anatomy
and absence of neurologic signs with or without learning difficulties.
 Diagnosis : is done by history & a thorough physical examination including
development assessment and measurement of head size of parents.
 Investigations: Neuroimaging
 D/D:
 Craniosyntosis: abnormal head shape with ridges along the suture lines
 Prognosis: Secondary poor> Primary
 MANAGEMENT OF MICROCEPHALY

 No Treatment
 Early intervention helps in enhancing the child's development
 Symptomatic management
 Drugs to control seizure, hyperactivity& other neuromuscular
symptoms.’
 Genetic counselling
 PREVENTION

 Preventing child birth after 35 years

 Screening for TORCH
 Thyroid screening
 Adequate nutrition
 Health education
 Genetic counselling
 HEARING LOSS

 Can be congenital or acquired

 2 types:
 Conductive
 Sensorineural
 Conductive hearing
Loss:
 Any process that
interferes with the
conductive mechanism
of the ear canal,
tympanic membrane, Crouzon
or ossicles. Syndrome
 otitis media with
effusion is the
common cause in Apert Syndrome
children
 congenital
syndromes: Apert,
Crouzon and
Treacher-Collins
syndrome
 Sensorineural hearing Loss:
 caused by a lesion of the cochlea, auditory nerve or central auditory pathway.
 common postnatal cause: meningitis
 common prenatal cause: intrauterine infection(TORCH infections, syphilis)
 Acquired causes: prematurity, hyperbilirubinemia, perinatal hypoxia, AIDS, head trauma
and ototoxic medications
 Congenital causes: Pendred syndrome, Jervell and Lange-Nielsen syndrome, Usher
syndrome, Alport's syndrome, branchio-oto-renal syndrome, neurofibromatosis and
Waardenburg syndrome
 Neonatal Screening:
 Any child with possible risk factors should be screened
 Screening tests: oto-acoustic emission test, auditory brainstem response
 Early detection of hearing loss can maintain language and speech development in children in line with their physical
development.
 Treatment of Hearing Loss
 based on the extent of deficit and the underlying pathology.
 mild hearing loss: preferential seating in school
 mild to moderate conductive hearing loss: tympanostomy tubes, Tympanoplasty
 sensorineural hearing loss:
 use of hearing aids from as early as 3 months of age,
 cochlear implants
 Sign language and deaf education programs should be considered for children
 SQUINT

 A squint is the term used when the two eyes are not pointing in the same direction
 not working together as a pair
 One eye may turn either inwards, outwards, downwards or upwards, whilst the other eye looks straight at
the target of interest.
 Types:
 Horrizontal
 Vertical
 HORIZONTAL SQUINT:
 ESOTROPIA: convergent squint- eye turns
inwards
 EXOTROPIA: divergent squint eye turns
outwards

 VERTICAL SQUINT:
 HYPERTROPIA: eye turns upwards
 HYPOTROPIA: eye turns downwards
 Causes:
 Uncorrected long sight (hypermetropia) is the most common reason for a convergent squint.
 Vision will be blurred and the effort required to see more clearly can cause one eye to turn inwards.
 Prescribing glasses to correct the long sight can help this inward turn and, in some cases, can completely
straighten the eyes.
 Occasionally a squint can be caused by a weak or abnormal eye muscle.
 In rarer cases a squint is a result of an abnormality of the eye(s) or eye nerve(s)
 Increased risk, if babies are born prematurely or for those who have other conditions, such as cerebral
palsy, Down’s syndrome or a general delay in development.
Treatment:
 Glasses:
 to correct long sight, short sight and/or astigmatism
 reduce the size of a squint and can occasionally straighten the eyes completely
 Patching:
 Patching is carried out to encourage the squinting eye to be used
 beneficial effect on the size of the squint,
 Surgery:
 All conservative treatments to be carried out before going for surgery
 Goal of surgery: To reduce the size of the squint, to improve the cosmetic appearance (how their eyes look); To re-
align the eyes, in order for them to work together (binocular vision). This will only be possible for some types of
squint.
 The procedure involves moving the muscles that control eye movement so that the eyes line up better.
 the eye is held open using an instrument called a lid speculum – sometimes it may be necessary to operate on both
eyes to get the alignment right
 the surgeon detaches part of the muscle connected to the eye and moves it into a new position so that the eyes point
in the same direction
 the muscles are fixed in their new position with dissolvable stitches – these are hidden behind the eye so you will not
be able to see them afterwards
 CONVULSION
 Also known as seizure/fits
 caused by abnormal electrical discharges from the brain resulting in abnormal involuntary, paroxysmal, motor, sensory,
autonomic or sensorial activity.
 Incidence: 5 percent children experience convulsions during the first five years of life.
 C/F:
 twitching of the limbs
 fluttering of the eyelids
 sucking movements
 Conjugate deviation of the eyes.
 STATUS EPILEPTICUS
 prolonged single seizureor multiple episodes of seizures lasting more than 30 min without regaining consciousness in between.
CAUSES
Management
 Goals:
 ensure adequate vitals
 systemic and cerebral oxygenation
 terminate seizure activity
 prevent seizure recurrence
 Establish the diagnosis and treat the underlying disorder.
 Emergency Supportive Treatment
 Secure the airway
 maintain oxygenation
 ensure perfusion,
 obtain intravenous access and protect the patient from hypoglycaemia, hyperthermia and injury
 Head and neck should be positioned to keep the airway open.
 Oxygen by nasal cannula or mask, if needed, is administered, endotracheal intubation may be
required.
 Systolic BP should be maintained at normal levels
 Anticonvulsant Treatment
 Goal of treatment is rapid termination of clinical and electrical seizure activity by the prompt administration of appropriate drugs in
adequate doses.
 Common Drugs Used are listed below
Status Epilepticus Management