Neurological Assessment of the Neonate

History

A complete history should include the following items:

• Exact age of the neonate in days. Gestational age (GA) at birth. Age of the mother. Pregnancy history of the mother (GPA: gravida, partuition, abortions).

• Important events during pregnancy such as fever, infections, bleeding, toxic exposures (e.g., drugs, medications, ethanol), fetal movements, level of prenatal care, results of prenatal laboratory tests, and whether an infertility evaluation was required prior to pregnancy.

• Delivery: Timing of rupture of membranes (ROM) prior to delivery, vaginal or cesarean delivery, and if assistance was required (vacuum or forceps), birth weight, Apgar scores (at 1, 5 and 10 minutes), and whether resucsitation was required after delivery.

• Perinatal course: Usually obtained from parents or from nursery staff. Important points include feeding (Breast feeding well? Poor nippler? Requires gavage feeds?), sleep/wake cycles (Normal sleep wake cycle? How much time in a day does the baby spend awake? Does the baby wake for feeding or does the baby have to be woken to feed?), crying (vigorous/weak/none) and spontaneous movements (vigorous/paucity of movement/none).

• Family history: Seizures (Neonatal? What age at onset?), mental retardation, miscarriages, infant deaths, other babies who were floppy, failed to thrive, or were dysmorphic, or consanguinity.

Pediatric Neurosurgery, edited by David Frim and Nalin Gupta. ©2006 Landes Bioscience.

Table 1. Normal development of the preterm infant

Age (weeks) Features

<26 Blinks to light (although eyelids are often fused)

Symmetric facial movements (e.g., grimace, cry) Lies in an extended posture Little or no resistance to passive movement No capacity for head control

26 Eyelids begin to open

Pupillary response absent Extended posture

28 Pupillary response can be detected

Tone noted in extremities

32 Sucking reflex begins, although sucking and swallowing are not coordinated

34 Sucking coordinated with swallowing

Head control noted

36 Adduction component of Moro reflex noted

38 - term Eye opening, visual fixation, pupillary response

Lies with all four extremities flexed Does not slip through hands when held Displays automatic 'standing' and 'stepping' reflexes when held upright

Table 2. Developmental milestones

Age

Language

Gross Motor

Fine Motor

Social

Newborn

vocalizes

equal movements

n/a

regards face

2 months

coos (ooh, ah)

head control

hands together

social smile

4 months

laughs/squeals

rolls over

reaches for toy

n/a

6 months

imitate speech sounds

sits w/o support

raking grasp

feeds self

8-10 months

babbling

pulling to stand

pincer grasp

indicates wants

12 months

first word

walking

puts object in cup

play ball

15 months

2-5 word vocabulary

walking well

scribbling

drinking from cup

2 years

combining 2

jumping

4-6 cube

dresses w/

words

tower

help

3 years

combining 3

balance 1 foot

copy circle

plays board

words

1 second

games

4 years

speech all understandable

hopping

copy cross

dress w/o help

in 19 ¿o'21 22'23 24 25'26'2> 28 29 30 32'33 34 35 36 37'3839'40

Figure 1. Normal head circumference charts for girls (A) and boys (B, shown on the following page) for the first 36 months of life based on the National Center for Health Statistics percentiles. Note the dramatic increase in head circumference in the first year of life.

in 19 ¿o'21 22'23 24 25'26'2> 28 29 30 32'33 34 35 36 37'3839'40

Figure 1. Normal head circumference charts for girls (A) and boys (B, shown on the following page) for the first 36 months of life based on the National Center for Health Statistics percentiles. Note the dramatic increase in head circumference in the first year of life.

Was this article helpful?

0 0

Post a comment