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[Standardized sonographic investigation of the lumbar spine in 247 newborns]
Insights
Ultrasound effectively diagnoses occult spinal dysraphism in newborns, even when not detected by routine screening. Early diagnosis via ultrasonography enables timely intervention and improved outcomes for infants with spinal malformations.
Area of Science:
- Neonatal screening
- Pediatric diagnostics
- Spinal cord imaging
Background:
- Occult spinal dysraphism often goes undiagnosed prenatally, unlike open spinal malformations.
- Newborns with occult spinal malformations may benefit from early diagnosis and intervention.
- Current neonatal screening primarily focuses on hip examinations, potentially missing spinal abnormalities.
Purpose of the Study:
- To evaluate the utility of neonatal ultrasound screening for detecting occult spinal dysraphism.
- To assess the feasibility and effectiveness of a standardized ultrasound protocol for infant spinal cord examination.
- To determine if ultrasound can identify spinal malformations not apparent through clinical examination or routine screening.
Main Methods:
- A prospective study screened the spinal cords of 247 newborns using ultrasound.
- A newly designed positioning device was used to standardize the prone examination.
- Clinical data, family history, and cutaneous stigmata were evaluated alongside sonographic findings.
Main Results:
- Ultrasound successfully visualized detailed cartilageous spinal cord and dural sac structures in all newborns.
- A novel positioning device standardized the examination, allowing for consistent imaging.
- No pathological spinal cord changes were detected in the study cohort, but the method's efficacy was confirmed.
Conclusions:
- Neonatal ultrasonography is a valuable tool for diagnosing suspected cases of occult spinal dysraphism.
- Standardized ultrasound protocols can reliably visualize infant spinal anatomy.
- Early detection through ultrasound facilitates timely management and follow-up for infants with spinal malformations.
Abstract:
Open dysraphism is generally known before birth due to prenatal screening but occult spinal malformation often remains unrecognized. Nevertheless, newborns with occult dysraphism could be easily diagnosed by ultrasound, which might be performed additionally to the neonatal screening of the hips. Early surgical treatment or close neuropediatric follow-ups could be administered as a consequence. As part of a prospective study-design, we screened the spinal cord of 247 newborns by ultrasound. Parents were interviewed about a positive family history, a folate intake during pregnancy, amniocentesis or chorionbiopsy. Clinically, cutaneous stigmata usually associated with occult spinal dysraphism were evaluated. An orthopedic and pediatric examination followed. The sonographic investigation was done in prone position using a newly designed positioning device. The sonographic examination was performed within 5 minutes and longitudinal and transversal pictures were taken for documentation. In all of the 247 examined newborns we were able to visualize the cartilageous structures of the spinal cord and the dural sack detailly. Dependent on the position of the newborn, variations of the width of the dural sack could be noted. Thus a newly designed positioning device helped to standardize the examination situation. We did not find any pathological changes of the spinal cord. Nevertheless ultrasonography provides a useful diagnostic tool in investigating the newborn where occult spinal dysraphism is expected.