Academic journal article International Journal of Child Health and Human Development

Neonatal Neurology

Academic journal article International Journal of Child Health and Human Development

Neonatal Neurology

Article excerpt

Introduction

Neonatal neurology requires an interdisciplinary approach that integrates maternal, placental, fetal, and neonatal perspectives into diagnostic and treatment algorithms concerning fetal/neonatal brain disorders (1-3). Most preterm newborns need neonatal neurology care. But they are not the only group. Term babies born with congenital disorders, those who were born to sick mothers or after complicated pregnancies are also in such a need. Four million babies are born per year in the United States and 11% of those are born premature. One percent of term infants have significant illnesses at birth that also require care in the neonatal intensive care unit (NICU) (1).

Ante-partum, peri-partum, and postnatal strategies for diagnosis and therapeutic intervention must adjust to the multiple time points and etiologies that define neonatal neurology disorders. Therefore, neonatal intensive care has grown extensively over the past 40 years (1). Currently, neonatology is a costefficient mode of intensive care (4). A greater number of infants at smaller gestational ages and weight are now surviving to discharge but this is only one step in a long journey for these small and often medically fragile infants (2). Newborn patients' brain disorders are unique. The synthesis of historical, clinical, and laboratory data implicate ante-partum, intra-partum, or postnatal time periods when brain damage occurred or was exacerbated.

Although the focus during the past decades has been on the saving of lives, it is also important to look beyond survival to issues of reducing morbidity and long-term neurological disabilities, as well as improving long-term developmental outcomes. There are promising interventions that can benefit survival as well as human development, and there is a huge public health needs to integrate these. Linking the agenda for maternal and newborn health with the emerging issues of long-term development, may well be the most appropriate strategy to ensure that we stay the course in solving one of the most important moral dilemmas of our times (3).

In this review we discuss the main issues most relevant in newborn neurology care.

Neurologic examination of the newborn

A comprehensive neurologic assessment should be performed in any newborn suspected to have a neurologic abnormality either based upon history or a physical finding detected during the routine neonatal assessment. Neurologists and neonatologists must frame the neurologic profile of the neonate in the context of the developmental niche (gestational maturity) during which an acquired or developmental disorder evolves. Therefore, every examination should start with estimation and mention of gestational age of the newborn.

Several authors have reported assessment of neurological functions in newborn infants (4,5). Some of these assessments have been adapted and validated for both infants born prematurely or at term. There have been number of publications that describe the newborn neurologic examination in different gestational ages aimed for different aspects (6). As in other age groups, the most relevant aspects of the newborn examination are: mental status, cranial nerves, motor and sensory examination, and the assessment of primitive reflexes (5).

These assessments can be easily and reliably used in both term preterm infants. Previously published data can help as a reference when examining newborn infant to see where the individual child stands compared with age-matched newborn infants and to identify signs that may be outside the reported range.

These assessment methods should be used routinely in the neonatal unit, at least in infants at risk of neurological abnormalities, since these examinations have been used and showed that they can reliably identify infants at risk of developing neurological abnormalities (6, 7).

Identifying early neurological abnormalities will allow early intervention, protection, and referral of these infants for rehabilitation and appropriate support for the families (5). …

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