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Application of the neonatal 'floppy module' to older infants: can it be used for differential diagnosis?
Costanza Cutrona1,2,3,4, Martina Sbarbati1,2,3, Martina Malaspina1,2,3
1Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
The neonatal floppy module, used for newborns, can be reliably used in infants aged 3 months and older. This tool aids in diagnosing infant hypotonia and identifying its causes, including neuromuscular, genetic, or central nervous system disorders.
Area of Science:
- Pediatrics
- Neurology
- Developmental Pediatrics
Background:
- Hypotonia is a common neonatal condition with diverse etiologies.
- Hypotonia can persist beyond the neonatal period, posing diagnostic challenges.
- The utility of the 'floppy module,' validated for newborns, in older infants requires investigation.
Purpose of the Study:
- To assess the applicability of the neonatal floppy module in infants aged 3 to 24 months.
- To establish the range of findings in low-risk infants using the floppy module.
- To explore the floppy module's potential in the differential diagnosis of hypotonia in infants.
Main Methods:
- The floppy module was administered to 159 low-risk infants (3-24 months) and 57 infants with hypotonia (older than 3 months).
- Data from 413 assessments were analyzed to determine the module's findings in different infant populations.
- Specific items within the module were evaluated for their diagnostic sensitivity.
Main Results:
- Low-risk infants showed findings consistent with previous newborn data, with tendon reflexes being the most variable item.
- Antigravity movement assessments were highly sensitive for detecting neuromuscular disorders.
- Dysmorphic features suggested genetic disorders, while seizures indicated central nervous system involvement.
Conclusions:
- The neonatal floppy module is reliably applicable to infants from 3 months of age.
- The module shows promise as a clinical tool to aid in the differential diagnosis of infant hypotonia.
Abstract:
In this study we applied the 'floppy module', originally developed for newborns with hypotonia, to older infants in order to establish the range of findings in both low-risk infants and in those with hypotonia due to different etiologies. Data were collected from 413 assessments obtained in 159 low-risk infants assessed at different ages between the age of 3 and 24 months. The distribution of findings in the low-risk infants was similar to the data previously obtained in low-risk newborns, with all assessments having optimal findings (column 3) on all items. The only item with a small number of findings outside column 3 was tendon reflexes. The module was also applied to a cohort of 57 infants with hypotonia older than 3 months in order to identify individual items that may be useful in differential diagnosis. Items assessing antigravity movements were the most sensitive to identify neuromuscular disorders. Dysmorphic features and other organ involvement were most suggestive of genetic disorder, while seizures were a reliable indicator of CNS involvement.
Conclusion:
Our findings suggest that the neonatal floppy module can be reliably administered also in infants from the age of 3 months. The pilot application of the module in infants with hypotonia from the age of 3 months also suggested that the module could be used to help the clinician in the differential diagnosis of infants with hypotonia.
What Is Known:
• Hypotonia is a relatively common finding in the neonatal period and can be due to multiple causes. • As hypotonia can be observed also after the neonatal period and clinicians often face the challenge of differential diagnosis, the question has arisen whether the 'floppy module' validated in newborns could also be used in infants.
What Is New:
• Most of the infants with hypotonia, between the age of 3 to 24 months, have a diagnosis of neuromuscular disorders. • Most of the infants with CNS involvement and with genetic diagnosis, who may have shown hypotonia in the neonatal period, by 6 to 12 months have normal or increased tone.
