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The skeleton and muscles
Published in Frank J. Dye, Human Life Before Birth, 2019
The plates of membranous bone making up the calvarium of the skull are each derived from a primary ossification center, from which bone formation spreads outward (Figure 14.5). However, the individual plates do not fuse with each other during prenatal development. As a consequence, newborn babies have unclosed sutures (in which two such bones come close together) and fontanelles (spaces in which more than two bones come together). These temporary discontinuities between the bones of the calvarium aid passage of the head through the birth canal at childbirth and permit an increase in the size of the skull to match brain growth after birth. The smaller fontanelles close during the first year, and the larger anterior fontanelle closes during the second year after birth. However, some of the sutures actually remain open until adulthood.
Head and neck
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Hydrocephalus is confirmed by observing an enlarged head circumference relative to that expected on a standard growth chart. Clinical signs of hydrocephalus include frontal bossing, a bulging fontanelle, wide sutures, dilated scalp veins and a small face. Also there may be ‘setting-sun eyes', where the iris is partly concealed by the lower lid; this is thought to be caused by compression of periaqueductal structures from raised intracranial pressure resulting in an upward gaze paresis. Severe hydrocephalus in infants can be demonstrable by transillumination of the skull (a bright light and a dark room are required), although an ultrasound scan is a more appropriate and accurate investigation.
Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In infants, the fontanelle is tense and bulging, with an increase in head circumference and bulging scalp veins. As pressure rises, conscious level is impaired. In children Pari- naud’s syndrome results from dorsal midbrain compression, with a loss of upgaze known as sunsetting (Figure43.2).
Factors influencing initiation and discontinuation of vitamin D supplementation among children 1-24-months-old
Published in Current Medical Research and Opinion, 2022
Selen Hurmuzlu Kozler, Tulin R. Saylı
In our study, 14.8% of children who were not supplemented were because of recommendations for discontinuation by family physicians. The primary reason for the recommendation of discontinuation among family physicians was the belief of sufficient duration of supplementation (61.3%) and the rate of withdrawal, for this reason, was higher among children aged between 13 and 24 months (79%) when compared to 1–12 months (21%). Other reasons were fontanel closure in seven patients and kidney stones in three patients. Similar to our study, Seymen Karabulut G. et al. reported that 20% of pediatricians who participated in their study stated that they discontinued vitamin D upon fontanel closure40. In the case of vitamin D deficiency, the closing of fontanelles is delayed, but normal or even high doses of vitamin D are not related to the early closure or smallness of fontanelles41. Vitamin D supplementation was shown not to be associated with an increased risk of kidney stones42,43.
Therapeutic drug monitoring of intravenous anti-tuberculous therapy: management of an 8-month-old child with tuberculous meningitis
Published in Paediatrics and International Child Health, 2021
Lucie Huynh, Cedric Agossah, Véronique Lelong-Boulouard, Julien Marie, David Brossier, Isabelle Goyer
An 8-month-old Albanian girl (5.7 kg, <1st percentile) presented to the paediatric emergency department of Caen University Hospital in a poor general state with transient fever, poor oral intake, weight loss for about 1 week and a 4-day history of a cough (Day 1). She had no relevant medical history. The recently immigrated family was living in overcrowded accommodation with relatives who had been coughing for several weeks. She had received two doses of the pneumococcal vaccines Prevnar 13® and Infanrix Hexa® (DTaP + IPV + HiB + HB) but no BCG. Her vital signs were normal for age (heart rate 150 bpm, respiratory rate 33/min, blood pressure 86/54 mmHg, temperature 37.3°C) and the general medical examination was normal (fontanelle closed, no neck stiffness, no disturbance of consciousness or vomiting), except for the cough and failure to thrive. She was hospitalised for nutritional support and investigated for her malnutrition.
Neisseria oralis septicaemia in a newborn: first recorded case
Published in Paediatrics and International Child Health, 2021
Gabriele Baniulyte, Sima Svirpliene, Andrew Eccleston, Sangeetha Arjunan, Martin Connor
A female infant was born by emergency caesarean section owing to fetal distress at 38 weeks to a 37-year-old mother of four. Her birthweight was 2250 g. The pregnancy had been uneventful and antenatal scans were normal. The delivery was complicated by prolonged rupture of membranes (48 hours) and meconium-stained and foul-smelling liquor. APGAR scores were 1 at 1 min, 9 at 5 min and 9 at 10 min. The mother did not suffer from intra-partum fever and did not require antibiotics. At birth, the infant was pale, had respiratory distress but no grunting and required resuscitation with suction as well as ventilation by mask for the first 4 minutes of life. After resuscitation, she was transferred to a neonatal intensive care unit and commenced on intravenous (IV) antibiotics (benzylpenicillin and gentamicin) after a septic screen. The vital signs at 10 mins of life included a temperature of 36.5°C, a pulse of 159 beats/min and a respiratory rate of 64 breaths/min. The fontanelle was normal.