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    Neonatal Hypotonia

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    iulia
    Neonatal hypotonia, or low muscle tone, can be central or peripheral in origin. Central hypotonia presents as a "floppy but strong" newborn with normal or hyperreflexia, while peripheral hypotonia appears "floppy but weak" with possible hyporeflexia. The document outlines the clinical features, etiologies, investigations, and primitive reflexes seen in neonatal hypotonia to guide physicians in determining the underlying cause.

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    Neonatal Hypotonia

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    iulia
    13 views1 page
    Neonatal hypotonia, or low muscle tone, can be central or peripheral in origin. Central hypotonia presents as a "floppy but strong" newborn with normal or hyperreflexia, while peripheral hypotonia appears "floppy but weak" with possible hyporeflexia. The document outlines the clinical features, etiologies, investigations, and primitive reflexes seen in neonatal hypotonia to guide physicians in determining the underlying cause.

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    2. Neonatal Hypotonia

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    Neonatal hypotonia, or low muscle tone, can be central or peripheral in origin. Central hypotonia presents as a "floppy but strong" newborn with normal or hyperreflexia, while peripheral hypotonia appears "floppy but weak" with possible hyporeflexia. The document outlines the clinical features, etiologies, investigations, and primitive reflexes seen in neonatal hypotonia to guide physicians in determining the underlying cause.

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    13 views1 page

    Neonatal Hypotonia

    Uploaded by

    iulia
    Neonatal hypotonia, or low muscle tone, can be central or peripheral in origin. Central hypotonia presents as a "floppy but strong" newborn with normal or hyperreflexia, while peripheral hypotonia appears "floppy but weak" with possible hyporeflexia. The document outlines the clinical features, etiologies, investigations, and primitive reflexes seen in neonatal hypotonia to guide physicians in determining the underlying cause.

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    of 1

    NEONATAL HYPOTONIA

    Neonatal hypotonia is defined as CLINICAL PRESENTATION


    poor tone in the muscles of the
    CENTRAL HYPOTONIA PERIPHERAL HYPOTONIA
    trunk, limbs and/or face. This
    “Floppy but strong” “Floppy but weak”
    means that the muscles provide
    little resistance when passively q Hypotonic posture but may q Frog-leg posture
    moved. Hypotonia can be
    respond to external stimuli q Reflexes may be normal or
    categorized as central or peripheral
    (see clinical presentation). It can
    with appropriate power hyporeflexive
    also be categorized as axial or q Reflexes normal or hyper- q Diffusely low muscle bulk
    truncal, predominantly affecting the reflexive and/or congenital contractures
    neck and spinal muscles; q Alertness and consciousness
    q Often show other CNS
    appendicular, affecting are preserved
    predominantly the extremities; or abnormalities: decreased level
    q Symmetrical or asymmetrical
    global. It may be identified early in of consciousness, seizures,
    pattern of weakness
    life when the newborn is unable to apnea, feeding difficulties, and
    obtain a normal posture during head shape abnormalities
    movement or at rest. q +/- Dysmorphic features

    HISTORY DIFFERENTIAL DIAGNOSIS


    q Timing and progression of hypotonia: acute vs chronic Acute Chronic
    q Prenatal history: abnormalities on US
    (polyhydramnios), chromosomal abnormalities, drug Systemic illness Genetic conditions
    exposures, infections during pregnancy, gestational q Sepsis/infection (ie. q Prader-Willi syndrome
    meningitis) q Down syndrome
    diabetes, hypertension, fetal movements.
    q Birth history: gestational age, mode of delivery, Metabolic conditions Neurological disorders
    forceps/vacuum, resuscitation, previous p9regnancies q Hypokalemia q Central
    q Systemic illness: GBS status, prolonged rupture of q Hypophosphatemia q Hypoxic-ischemic
    membranes, maternal fever, electrolyte abnormalities q Hypocalcemia encephalopathy
    q Genetic causes: family history, especially neurological q Hypo/hypernatremia q Malformations of
    brain development
    Genetic conditions q Intracranial bleeds
    PHYSICAL EXAM q Prader-Willi syndrome or strokes
    q Down syndrome
    q General Appearance: Vital signs, level of q Peripheral
    q Spinal muscular
    consciousness, signs of systemic illness, contractures
    atrophy
    q Skin: rashes, jaundice, cyanosis
    q Myasthenia gravis
    q HEENT: dysmorphic features q Congenital
    q Neuro: fasciculations, CN exam, primitive and distal myopathies or
    reflexes, observe spontaneous movements muscular
    q Horizontal and vertical suspension, traction response dystrophies

    PRIMITIVE REFLEXES* INVESTIGATIONS


    q Palmar grasp (a) q Galant (f) Guided by history and physical.
    q Plantar grasp (b) q Landau (g) Systemic illness: septic workup, lytes, LFTs, ammonia, lactate
    q Rooting (c) q Parachute (h) Neurologic causes: MRI brain +/- EEG; CK,
    q Moro (d) q Positive support (i) electromyography/nerve condition study, muscle biopsy.
    q Asymmetric tonic q Placing and Genetic/metabolic: karyotype and microarray analysis, genetic
    neck (e) stepping (j) testing for specific disorders, newborn metabolic screen and further
    *See note on Primitive Reflexes for more information. metabolic testing as indicated.

    (a) (b) (c) (d) (e) (f) (g) (h) (j)

    Published March, 2021


    Morgan Gregg (Medical Student, University of Alberta) and Dr. Nicole Anderson (Neonatal-Perinatal Fellow,
    University of Alberta) for www.pedscases.com.

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