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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.
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).
Clinical examination
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
Thus from this evidence it seems that sunken eyes, a sunken fontanelle and dry mucous membranes offer little help in making a positive diagnosis of 5% dehydration due to the low likelihood ratios and the range of kappa values (from poor to moderate agreement). Dehydration is less likely in the absence of dry mucous membranes as this exhibits the lowest negative likelihood ratio and also has a more acceptable range of kappa values than many of the other physical signs.
The Eyes Have It: How Critical are Ophthalmic Findings to the Diagnosis of Pediatric Abusive Head Trauma?
Published in Seminars in Ophthalmology, 2023
Cynthia K Harris, Anna M Stagner
Discussion of intracranial pressure elevations is complicated by the open cranial sutures and non-ossified fontanels characteristic of the infant skull. Unlike adults or even older children in whom the cranial sutures are fused, the open sutures of the infant allow for initial compensation of increases in intracranial pressure with bulging of the fontanels. As a result of this “open system,” one could argue that papilledema might not occur in infants with increased intracranial pressure, except at more advanced stages. In this view, the low percentage of infants with papilledema in the above cohorts might not indicate a correspondingly low percentage of infants with normal (or non-significantly elevated) intracranial pressure. Indeed, many of the clinical presentations of the presumed abused infant—such as irritability, vomiting, and convulsions—can be manifestations of raised intracranial pressure.14,54 To speculate on this question is beyond the scope of this paper and the authors’ respective areas of expertise. Skepticism must be raised, however, that an increase in intracranial pressure could lead to widespread retinal hemorrhages and retinoschisis when that pressure is otherwise insufficient to cause papilledema. Moreover, no study to our knowledge has shown that increased intracranial pressure causes retinal hemorrhages beyond those specifically associated with papilledema in the prepapillary or peripapillary regions.43
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.
Clinical, biochemical and molecular spectrum of mild 6-pyruvoyl-tetrahydropterin synthase deficiency and a case report
Published in Fetal and Pediatric Pathology, 2021
Boyan Song, Zhijun Ma, Wei Liu, Lihong Lu, Yongjian Jian, Lu Yu, Zhihui Wan, Xiaofei Yue, Yuanyuan Kong
The patient is a female infant, delivered vaginally after 40 weeks of pregnancy, with a birth weight of 3430 g and a body length of 51 cm. The neonatal screening showed that the patient’s blood phenylalanine level was 221.6 µmol/L (reference range: 30–117 µmol/L). At day 21 after birth, she was admitted to our hospital. The phenylalanine level in blood was 859.6 µmol/L. No manifestations, such as skin whitening and yellowing, poor appetite, sucking weakness, dysphagia, decreased responsiveness, weakness, somnolence or convulsions were detected. No specific odor was found in urine. Moreover, jaundice, rash, and bleeding spots were not observed on the skin. No unusual facies and no yellow hair were observed. The anterior fontanel was flat and soft, and the tension was not high. Because getting results of urine pterin spectrum analysis and dihydropteridine reductase (DHPR) analysis for further diagnosis need several days, a low phenylalanine diet was administered.