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Spinal dysraphism in newborns: Screening factors for prioritizing rapid spinal ultrasonography from a retrospective
Lorena Wagnez1, Mélodie-Anne Karnoub2, Thameur Rakza3
1Pediatric Emergency department, pole Femme Couple Enfant, Amiens University Hospital, Amiens, France.
Insights
Gluteal cleft abnormalities in infants are strong indicators for spinal dysraphism screening via ultrasonography (USG). Simple sacral dimples, however, are associated with normal USG results, helping to avoid unnecessary tests.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Medical imaging
Background:
- Spinal dysraphism, a common congenital condition, presents as open or occult forms.
- Diagnosis typically involves clinical examination and spinal ultrasonography (USG), but clinical signs are often non-specific.
- Prioritizing infants for USG is crucial to avoid unnecessary screening and ensure timely diagnosis.
Purpose of the Study:
- To evaluate the association between specific clinical signs and spinal USG findings in infants.
- To identify clinical indicators predictive of high risk for spinal dysraphism.
- To improve the efficiency of spinal USG screening in neonates.
Main Methods:
- A retrospective cohort study was conducted from January 2017 to December 2021.
- Infants screened for spinal dysraphism via USG based on lumbosacral clinical indicators were included.
- Clinical characteristics were collected and compared between infants with normal and abnormal USG results.
Main Results:
- Of 144 infants, 22.2% had abnormal USG results indicative of occult dysraphism.
- Simple sacral dimples were strongly associated with normal USG results (RR = 0.32).
- Gluteal cleft abnormalities showed a significant association with abnormal USG results (RR = 3.09).
Conclusions:
- Clinical signs like gluteal cleft abnormalities can help prioritize infants for spinal USG.
- Simple sacral dimples are less indicative of dysraphism, potentially reducing unnecessary USG.
- A diagnostic tree approach could optimize USG use and facilitate international comparative studies.
Background:
Spinal dysraphism is a common condition and may be either open or occult. Occult dysraphism is generally diagnosed in the postnatal period through clinical examination and spinal ultrasonography (USG). Clinical signs of spinal dysraphism are common and not specific. Several spinal USG are required to confirm or exclude this condition. It is crucial to identify the infants at highest risk of dysraphism for rapid USG, and avoid unnecessary screening. The aim of the study was to evaluate the relationship between clinical examination signs and spinal USG examination results to determine which clinical signs are associated with a high risk of dysraphism, to facilitate the prioritization of infants for spinal USG examinations.
Patients And Methods:
We performed a retrospective cohort study in a regional neurosurgical and neonatal reference center, from January 2017 to December 2021. All infants undergoing screening for spinal dysraphism by USG during this period based on clinical indicators in the lumbosacral region were included. Infants who underwent spinal USG as part of a systematic assessment were excluded. The primary outcome was the incidence of abnormal USG results. The clinical characteristics of patients with suspected dysraphism were collected and compared between groups.
Results:
We included 144 patients, 22.2 % USG results were abnormal suggesting occult dysraphism. USG was performed due to the presence of a simple sacral dimple in 41.7 % infants which was strongly associated with a normal USG result (RR = 0.32 95 %CI [0.14 - 0.70]; p = 0.0029), whereas abnormal USG results were more frequent in patients with gluteal cleft abnormalities (RR = 3.09 95 %CI [1.5 - 5.2]; p = 0.0029).
Conclusion:
Clinical signs such as sacral dimple or gluteal cleft abnormality could help prioritizing USG. The use of a diagnostic tree based on a "step-by-step" model would make it possible to avoid some unnecessary USG and would allow comparative international studies.
