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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

A 3-month-old infant with upper extremity weakness.

¹Division of Hospital Medicine, Children's Hospital Los Angeles, CA, USA. rzipkin@chla.usc.edu

Pediatric Annals

|March 27, 2012

Summary

Pediatric acute neurological changes require thorough history, exam, and imaging. Rare neurenteric cysts/fistulas and epidural abscesses necessitate comprehensive spinal evaluation, especially with gram-negative infections.

Area of Science:

Pediatric Neurology
Spinal Cord Imaging
Infectious Diseases

Background:

Acute neurological changes in children demand prompt medical attention.
Neurenteric cysts, fistulas, and epidural abscesses are rare pediatric spinal conditions.
Understanding the etiology is crucial for effective management.

Observation:

Neurenteric cysts/fistulas typically occur in the cervicothoracic region, causing cord/brainstem compression.
Epidural abscesses are found in the thoracic or lumbar regions.
Infections with S. aureus are common without GI-spinal communication; gram-negative pathogens (E.coli, E. cloacae) suggest neurenteric fistulas.

Findings:

Prompt neuroimaging aids in determining the extent of neuronal involvement.

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Associated infections can occur with neurenteric anomalies.

Gram-negative pathogens strongly indicate the need to rule out neurenteric fistulas.

Implications:

Complete spinal canal evaluation is essential due to potential anomalies associated with neurenteric cysts.
Early diagnosis and targeted treatment based on pathogen identification are critical.
This approach improves outcomes for children with rare spinal pathologies.