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Published on: January 7, 2020
Neonatal tone management
Roshirl Francisco1, Stacey Hall2, Geetanjali Rathore3
1Division of Child Neurology, Department of Pediatrics, The University of Texas Health Science Center at Houston McGovern Medical School, USA.
Insights
Neonatal tone abnormalities may signal cerebral palsy (CP). Early diagnosis and multidisciplinary care are vital for optimal outcomes in infants with CP, despite limited current guidelines.
Area of Science:
- Neurology
- Developmental Pediatrics
- Physical Medicine & Rehabilitation
Background:
- Neonatal tone abnormalities are early indicators of cerebral palsy (CP).
- Early diagnosis and intervention during peak neural plasticity are critical for managing CP.
- Current clinical guidelines and evidence for treating neonatal tone abnormalities are insufficient.
Purpose of the Study:
- To review the physiology of neonatal tone abnormalities.
- To provide a guideline for assessing neonates with suspected tone abnormalities.
- To outline multidisciplinary care and treatment options for neonatal tone abnormalities.
Main Methods:
- Review of the physiology of motor control and injury etiology.
- Guideline development for neonatal tone assessment, including diagnostic and rating scales.
- Description of non-pharmacological, pharmacological, and surgical interventions.
Main Results:
- Physiology of tone abnormalities and their structural-functional components are discussed.
- A structured approach to neonatal tone assessment is provided.
- Multidisciplinary care and various treatment modalities are detailed.
Conclusions:
- Regular, serial examinations are essential for monitoring tone abnormalities in neonates.
- Early and comprehensive management involving a multidisciplinary team improves outcomes for infants with CP.
- Addressing tone abnormalities requires a coordinated approach encompassing assessment, diagnosis, and tailored interventions.
Abstract:
Neonatal tone abnormalities can often be the first indication of cerebral palsy (CP) and need regular developmental assessments by a multidisciplinary team. The need for early diagnosis and treatment during the height of neural plasticity is crucial. Currently, the number of clinical practice guidelines and the quality of evidence for treatment of tone in neonates is insufficient. In this review, we discuss the physiology of tone abnormalities including structural-functional components of motor control and time-dependent etiology of injury. We provide a guideline for assessment of a neonate with concern for tone abnormalities including a discussion on available diagnostic and functionality rating scales. Lastly, we describe the importance of a multidisciplinary care team involving the patient's caregiver as well as non-pharmacological, pharmacological, and surgical treatment options for tone abnormalities. We stress the importance of regular, serial examinations for tone as these neonates get older to assess eligibility for additional interventions.
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