6.2.8. Neonatology - Common Post-Natal Problems - Neurology

Question 1

What are the Common Neurological Problems of the Neonate?

Answer 1

1. Spinal Dimples
2. Cephalohaematomas
3. Caput Succedaneium
4. Brachial Palsy - Erb’s Palsy / Klumpke’s Palsy
5. Facial Palsy
6. Asymmetric Crying Facies

Question 2

What are the Types of Spinal Dimples?

Answer 2

1. Benign Sacral Dimples
2. Spina Bifida Occulta
3. Kidney Related Spinal Dimple

Question 3

What are the Features of a Benign Sacral Dimples?

Answer 3

1. Indentation in the Skin on the Lower Back
2. Present at the Time of Birth
3. Usually Small / Shallow
4. Minor and do not need Medical Treatment

Question 4

What is used to make a Clear Diagnosis / Rule out more Serious Conditions?

Answer 4

1. Ultrasounds

2. MRI

Question 5

What is the Criteria for the Dimple to require Further Investigation?

Answer 5

1. Large
2. Red
3. Swollen
4. Off Midline
5. Higher than Sacral Area
6. Pigmented
7. Tender
8. Accompanied by Fluid

Question 6

What is a Cephalohaematoma?

Answer 6

Haemorrhage beneath the Pericranium

Question 7

What is the Presentation of a Cephalohaematoma?

Answer 7

A Localized Soft, Non-Translucent Swelling over One or Both Sides of the Head

Question 8

When does a Cephalohaematoma become Maximal Size?

Answer 8

3-4 Day of Life

Question 9

What are the Limits of Cephalohaematomas?

Answer 9

One of the Cranial Bones - Usually the Parietal Bone

Question 10

What is the Treatment of a Cephalohaematoma?

Answer 10

No Treatment Required - Resolution occurs in 3-4 weeks

Question 11

What can a Cephalohaematoma be associated with?

Answer 11

Increased Haemolysis - Neonatal Jaundice

Note - No Association with Intracranial Bleeding

Question 12

What is Caput Succedaneum?

Answer 12

Serosanguinous Sebaceous Fluid Collection with Poorly Defined margins

Question 13

What causes Caput Succedaneum?

Answer 13

Pressure of the Presenting Part of the Scalp Against the Dilating Cervix during Delivery

Question 14

What is the Presentation of Caput Succedaneum?

Answer 14

1. Scalp Swelling that Extends across the Midline and over Suture Lines
2. Associated with Head Moulding

Question 15

What are the Features of Caput Succedaneum?

Answer 15

1. Does not cause Complications

2. Resolves over the First Few Days

Question 16

When do Brachial Plexus Injuries occur?

Answer 16

During Difficult Deliveries

Question 17

What are the Features of Erb’s Palsy?

Answer 17

1. Upper Arm
2. Waiter’s Tip
3. Common

Question 18

What are the Features of Klumpke’s Palsy?

Answer 18

1. Lower Arm / Hand

2. Rare

Question 19

What is the Most Common Peripheral Nerve Injury in Neonates?

Answer 19

Unilateral Facial Nerve Palsy

Question 20

What are the Causes of Facial Nerve Palsy?

Answer 20

1. Direct Trauma from Foreceps

2. Compression of the Nerve against the Sacral Promontory

Question 21

What is the Presentation of Facial Palsy?

Answer 21

1. Decreased Facial Movement
2. Forehead Wrinkling on the Side of the Palsy
3. Eyelid Elevation
4. Flattening of the Nasolabial Folds
5. Flattening of the Corner of the Mouth
6. Asymmetrical Movement of the Mouth
   Note - Crying Accentuates the Findings

Question 22

What Differentiates Asymmetric Crying Facies from Facial Nerve Palsy?

Answer 22

Eye / Forehead Muscles are Unaffected

Question 23

What is the Cause of Asymmetric Crying Facies?

Answer 23

1. Congenital Deficiency
2. Absence of the Depressor Anguli Oris (DAO)
   Note - DAO controls the Downward Motion of the Lip

Question 24

What is the Presentation of Asymmetric Crying Facies?

Answer 24

1. Left Side is more common
2. Lip Asymmetry apparent when Smiling / Crying
3. Other Facial Features are Symmetrical

Question 25

What is Asymmetric Crying Facies associated with?

Answer 25

1. Cardiovascular Defects 2. Musculoskeletal Defects 3. Genitourinary Defects 4. Respiratory Defects 5. 22q11 Deletion