Neurologic and Musculoskeletal Complications of the Newborn
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| Define Hydrocephalus: | Condition caused by an imbalance in the production and absorption of CSF in the ventricles of the brain
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| What is hydrocephalus often associated with? | myelomeningocele
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| What may hydrocephalus be a result of? | of a preexisting developmental defect such as Arnold-Chiari malformation or Dandy-Walker Syndrome
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| What is an Arnold-Chiari Malformation? | Congenital anomaly in which the cerebellum and medulla oblongata extend down through the foramen magnum
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| What is Dandy-Walker Syndrome? | When the enlarged head involves a prominent occiput, the condition usually involves an atresia (closing) of the foramen of Lushka and Magendie
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| Visual S/Sx of hydrocephalus: | *Fontanel is full or bulging *Head is enlarged *Setting-sun is apparent
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| What are the primary tools for diagnosing hydrocephalus? | CT and MRI
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| Tx of hydrocephalus: | *Direct removal of an obstruction (such as tumor) *Placement of a shunt (such as a Ventriculoperitoneal Shunt)
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| Nursing care for hydrocephalus: | *Observe for S/Sx of ICP *Measure the head circumference daily at point of largest measurement and record *Gently palpate fontanels and suture lines for S/Sx of bulging, tenseness and separation. Observe for bulging during crying/straining
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| After a ventriculoperitoneal shunt is placed in an infant, how should they be positioned? | *On unoperated side to prevent pressure on the shunt valve and pressure areas *Keep flat to help avert complications resulting from too-rapid reduction of intracranial fluid
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| After a ventriculoperitoneal shunt is placed in an infant to Tx hydrocephalus, what do S/Sx of ICP indicate? | an obstruction of the shunt
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| What can abdominal distension in an infant with a ventriculoperitoneal shunt indicate? | peritonitis or postoperative ileus as a complication of distal catheter placement
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| What are the two classifications for hydrocephalus? | Communicating and noncommunicating hydrocephalus
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| What is Spina Bifida? | Midline defect involving failure of the bony spine to close
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| What are the two types of Spina Bifida? | *Spina Bifida Occulta *Spina Bifida Cystica
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| Where does Spina Bifida Occulta occure most frequently? | In the lumbosacral area
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| How does Spina Bifida Occulta appear on visual inspection? | It is seen by a dimple on the back, which may have a tuft of hair over it
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| What form of Spina Bifida appears as a visible defect with an external sac-like structure? | Spina Bifida Cystica
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| What are the two forms of Spina Bifida Cystica? | *Meningocele: meninges and spinal fluid *Meningomyelocele: contains meninges, nerve roots, spinal cord, and spinal fluid
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| When does therapeutic management of Spina Bifida Cystica offer the most favorable outcome? | Early closure within the first 24 to 72 hours
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| True or False: Early Tx of Spina Bifida Cystica within 24-72 hours of birth with improved surgical techniques do NOT alter major physical disability, spinal defect, or chronic UTIs that affect these infants | True.
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| True or False: In newborns, Cleft Palates are always accompanied by Cleft Lips. | False. Occur together or separately, on one or both sides
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| What causes Cleft Lip? | a failure of the maxillary and median nasal processes to fuse
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| Fill in the blanks: Unilateral Clefts in cleft lip/palate occur _____ as frequently on the _____ side. | Twice, Left
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| In cleft lip/palate, how much more common are unilateral clefts than bilateral clefts? | 9 times more common
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| Smoking increases the risk of cleft lip/palate by how much | Twice the risk
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| For cleft lip/palate, prenatal diagnosis with ultrasound is not reliable until when? | the soft tissues of the fetal face can be visualized at 13 to 14 weeks
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| When is surgery for cleft lip performed? | By 3 months. Further surgery may be needed at 4 to 5 years.
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| How is surgery done for cleft palate? | Palate repair surgery is done in stages, depending on the degree, usually beginning before one year to minimize speech problems
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| What provides an efficient, safe feeding device if the infant with cleft lip/palate has trouble with nipple feeding? | *Rubber-tipped medicine stopper *Asepto syringe *Breck feeder (a large syringe with soft rubber tubing)
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| What position must an infant with cleft palate be fed, and why? | *Feed infant in an upright position because milk enters nasal passages through the palate, causing an increased tendency to aspirate
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| True or False: Post-op care of the infant who recieved surgery for cleft lip also includes arm and elbow restraints. | True.
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| How must the post-op cleft lip infant be placed? | On back or side
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| How must the post-op cleft palate infant be placed? | On abdomen
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| What is congenital clubfoot? | A complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus and ankle equinus
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| In typing congenital clubfoot, what is Talipes varus? | an inversion or bending inward
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| In typing congenital clubfoot, what is Talipes valgus? | an eversion or bending outward
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| In typing congenital clubfoot, what is Talipes equines? | plantar flexion in which the toes are lower than the heel
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| In typing congenital clubfoot, what is Talipes calcaneus? | dorsiflexion, in which the toes are higher than the heel
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| What are the four types of congenital clubfoot? | *Talipes varus *Talipes valgus *Talipes equines *Talipes calcaneus
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| What is the most frequently occuring type of clubfoot? | talipes equinovarus (TEV)
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| What are the causes of clubfoot? | *Abnormal positioning and restricted movement in utero *Arrested or abnormal embryonic development
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| What is the management of clubfoot? | *Serial casting is begun shortly after birth, before discharge from the nursery *Manipulation and casting are repeated weekly to accommodate rapid growth, usually within 8 to 12 weeks
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| If there is a failure to achieve normal alignment withing 3 months in an infant with clubfoot, what is done? | surgical intervention, which may take place between 6 and 12 months of age
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| What is Acetabular dysplasia (or preluxation)? | Mildest form of Developmental Hip Dysplasia (DDH) in which there is neither subluxation nor dislocation. Femoral head remains in the acetabulum
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| What is Developmental Hip Dysplasia (DDH) Subluxation? | A form of DDH where Femoral head remains in contact with acetabulum, but a stretched capsule and ligamentum teres cause the head to be partially displaced
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| What is Developmental Hip Dysplasia (DDH) Dislocation? | A form of DDH where femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim
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| What tests demonstrate the tendency for subluxation and dislocation in DDH? | Ortolani or Barlow tests
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| How is DDH managed in newborns to 6 months of age? | (Pavlik harness is the most widely used) Hip joint is maintained by dynamic splinting in a safe position with the proximal femur centered in the acetabulum in an attitude of flexion
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| How long does the Tx of DDH with a Pavlik harness generally last? | 3 to 5 months
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| Why can it take up to 6-18 months before DDH is recognized? | Sometimes it is minor enough to not be noticed until the infant is old enough to begin to stand and walk.
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