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Hypotonia in the Newborn

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Common Problems in the Newborn Nursery
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Abstract

This chapter discusses the clinical approach to a newborn presenting with hypotonia in the newborn nursery. Various etiologies are discussed using a step-by-step approach to ruling out the differential diagnoses in a question-based format. The discussion is aimed at the nursery provider and provides an algorithmic approach to diagnosing the most common etiologies that can present with hypotonia in a newborn. A brief discussion of systemic causes of hypotonia is also presented followed by a basic diagnostic workup for the respective scenarios. This chapter further discusses how to differentiate central causes from peripheral causes of hypotonia in a newborn.

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References

  1. Crawford TO. Clinical evaluation of the floppy infant. Pediatr Ann. 1992;21(6):348–54.

    Article  Google Scholar 

  2. Martin K, Inman J, Kirschner A, Deming K, Gumbel R, Voelker L. Characteristics of hypotonia in children: a consensus opinion of pediatric occupational and physical therapists. Pediatr Phys Ther. 2005;17(4):275–82.

    Article  Google Scholar 

  3. Dubowitz V. Evaluation and differential diagnosis of the hypotonic infant. Pediatr Rev. 1985;6(8):237–43.

    Article  Google Scholar 

  4. Dubowitz V. The floppy infant. 2nd ed. London: Spastics International Medical Publications: in association with W.H. Heinemann/Philadelphia: J.B. Lippincott; 1980. 158 p.

    Google Scholar 

  5. Leyenaar J, Camfield P, Camfield C. A schematic approach to hypotonia in infancy. Paediatr Child Health. 2005;10(7):397–400.

    Article  Google Scholar 

  6. Fenichel GM. The hypotonic infant. In: Fenichel GM, editor. Clinical pediatric neurology. 4th ed. Philadelphia: WB Saunders Company; 2001. p. 149.

    Google Scholar 

  7. Tuysuz B, Kartal N, Erener-Ercan T, Guclu-Geyik F, Vural M, Perk Y, et al. Prevalence of Prader-Willi syndrome among infants with hypotonia. J Pediatr. 2014;164(5):1064–7.

    Article  Google Scholar 

  8. Hamza A, Herr D, Solomayer EF, Meyberg-Solomayer G. Polyhydramnios: causes, diagnosis and therapy. Geburtshilfe Frauenheilkd. 2013;73(12):1241–6.

    Article  CAS  Google Scholar 

  9. Kowalczyk B, Feluś J. Arthrogryposis: an update on clinical aspects, etiology, and treatment strategies. Arch Med Sci. 2016;12(1):10–24.

    Article  Google Scholar 

  10. Hogan L, Ingemarsson I, Thorngren-Jerneck K, Herbst A. How often is a low 5-min Apgar score in term newborns due to asphyxia? Eur J Obstet Gynecol Reprod Biol. 2007;130(2):169–75.

    Article  Google Scholar 

  11. Peredo DE, Hannibal MC. The floppy infant. Evaluation of hypotonia. Pediatr Rev. 2009;30(9):e66–76.

    Article  Google Scholar 

  12. Ahmed MI, Iqbal M, Hussain N. A structured approach to the assessment of a floppy neonate. J Pediatr Neurosci. 2016;11(1):2–6.

    Article  Google Scholar 

  13. Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: a population-based study in term infants. J Pediatr. 2001;138(6):798–803.

    Article  CAS  Google Scholar 

  14. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001;344(7):467–71.

    Article  CAS  Google Scholar 

  15. Nelson KB, Ellenberg JH. Apgar scores as predictors of chronic neurologic disability. Pediatrics. 1981;68(1):36–44.

    CAS  PubMed  Google Scholar 

  16. Ehrenstein V. Association of Apgar scores with death and neurologic disability. J Clin Epidemiol. 2009;1:45–53.

    Article  Google Scholar 

  17. Cotten CM, Shankaran S. Hypothermia for hypoxic–ischemic encephalopathy. Expert Rev Obstet Gynaecol. 2010;5(2):227–39.

    Article  Google Scholar 

  18. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353(15):1574–84.

    Article  CAS  Google Scholar 

  19. Volpe JJ. Specialized studies in the neurological evaluation. In: Volpe JJ, editor. Neurology of the newborn. Philadelphia: Saunders Elsevier; 2008. p. 154–202.

    Google Scholar 

  20. Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2010;77(10):1123–8.

    Article  Google Scholar 

  21. Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575–9.

    Article  Google Scholar 

  22. Ali A, Walentik C, Mantych GJ, Sadiq HF, Keenan WJ, Noguchi A. Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics. 2003;112(1 Pt 1):e70–2.

    Article  Google Scholar 

  23. Paro-Panjan D, Neubauer D. Congenital hypotonia: is there an algorithm? J Child Neurol. 2004;19(6):439–42.

    Article  Google Scholar 

  24. Volpe JJ. Neurological examination: normal and abnormal features. In: Volpe JJ, editor. Neurology of the newborn. Philadelphia: Saunders Elsevier; 2008. p. 121–48.

    Google Scholar 

  25. Dubowitz LM, Dubowitz V, Palmer P, Verghote M. A new approach to the neurological assessment of the preterm and full-term newborn infant. Brain Dev. 1980;2(1):3–14.

    Article  CAS  Google Scholar 

  26. Balmakund J. Hypotonia in children: an approach for evaluation and treatment. Resid Staff Physician. 1997;43(9):74–89.

    Google Scholar 

  27. Vasta I, Kinali M, Messina S, Guzzetta A, Kapellou O, Manzur A, et al. Can clinical signs identify newborns with neuromuscular disorders? J Pediatr. 2005;146(1):73–9.

    Article  Google Scholar 

  28. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696–705.

    Article  CAS  Google Scholar 

  29. Shankaran S, Woldt E, Koepke T, Bedard MP, Nandyal R. Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants. Early Hum Dev. 1991;25(2):135–48.

    Article  CAS  Google Scholar 

  30. Igarashi M. Floppy infant syndrome. J Clin Neuromuscul Dis. 2004;6(2):69–90.

    Article  Google Scholar 

  31. Wang P, Zhou W, Yuan W, Huang L, Zhao N, Chen X. Prader-Willi syndrome in neonates: twenty cases and review of the literature in Southern China. BMC Pediatr. 2016;16:124.

    Article  Google Scholar 

  32. Devlin L, Morrison PJ. Accuracy of the clinical diagnosis of Down syndrome. Ulster Med J. 2004;73(1):4–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. McSweeney N, Cowan F, Manzur A, Robb S, Muntoni F. Perinatal dyskinesia as a presenting feature in Prader Willi syndrome. Eur J Paediatr Neurol. 2009;13(4):350–5.

    Article  Google Scholar 

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Correspondence to Ranjith Kamity MD FAAP .

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Kamity, R. (2019). Hypotonia in the Newborn. In: Martin, G., Rosenfeld, W. (eds) Common Problems in the Newborn Nursery. Springer, Cham. https://doi.org/10.1007/978-3-319-95672-5_16

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  • DOI: https://doi.org/10.1007/978-3-319-95672-5_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95671-8

  • Online ISBN: 978-3-319-95672-5

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