How to diagnose neurologic problems in neonates

Among the many conditions that pediatricians encounter in their practice are neurological issues in newborns, which, according to Courtney Wusthoff, MD, FAAP, can make some neurologists uncomfortable.

“Every pediatrician needs to be able to approach common neurologic issues in babies, and be able to identify the more rare but potentially serious ‘don’t miss’ findings and diagnoses,” said Wusthoff, assistant professor of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California.

In the session “Nagging questions: Am I missing something serious?” held on Monday, October 24, Wusthoff, along with Sabrina Smith, MD, PhD, Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California, described a number of neonatal neurology issues about which they commonly get questions from pediatricians.

These issues include abnormal head size, café au lait spots, abnormal tone, and funny movements, as well as encephalopathy. In discussing encephalopathy, the presenters emphasized the distinction between hypotonia, neonatal encephalopathy, and hypoxic-ischemic encephalopathy (HIE) to help pediatricians recognize that these are not interchangeable conditions, as sometimes thought, even though they all share overlapping features.

“It is a crucial distinction because we see children in hospital and in our clinics far too often who have a missed neuromuscular cause of hypotonia or missed cause of cerebral palsy because they were just labeled with HIE,” said Wusthoff, adding that “a misdiagnosis of HIE can result in a child missing out on appropriate treatment and in misdirected blame and guilt among parents.”

To help pediatricians gain confidence in tackling neurologic problems in newborns, Wusthoff and Smith described an efficient and evidence-based approach to doing a neonatal neurology exam called the Dubowitz exam. “Despite the common myth that you can’t do a neuro exam in a newborn, pediatricians using the Dubowitz exam have interrater reliability of >90% and can identify 95% of preterm babies with neurological abnormalities,” said Wusthoff.

The presenters also described emerging technology in brain monitoring for newborns along with a practical approach for making the initial evaluation of a newborn with possible seizures.

“Our hope is that this session gave pediatricians the tools they need to be confident in taking the first steps in evaluating or managing these neonatal neurology issues,” said Wusthoff.

Ms Nierengarten, a medical writer in Minneapolis, Minnesota, has over 25 years of medical writing experience, authoring articles for a number of online and print publications, including various Lancet supplements, and Medscape. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.