A hypotonic infant can be a typical case in neurology station. It is also likely to see one in your clinic

The following points are mandatory

Points to remember in Prenatal History:

  • History of TORCH infections
  • History of antenatal Drugs or alcohol
  • Any Maternal illness
  • Fetal movements- normal or hypoactive?

Points in Neonatal History:

  • Complications during Delivery- Prolonged delivery, Blood loss
  • Gestation at delivery- Term or preterm or post-term
  • Seizures history- Age of presentation, Type of seizures, medications
  • Initial presentation of hypotonia- Symptoms and signs

Past Medical History:

  • History of presenting symptoms
  • Associated symptoms
  • Symptoms of the systemic disease
  • The rate of symptom progression
  • Developmental History
  • Delayed milestone attainment
  • Loss of milestones
  • Motor, social and language incongruence
  • Feeding History

Choking or aspiration

Constipation

Family History:

  • Other members affected
  • Sudden deaths in the family
  • Consanguinity
  • Developmental delay
  • Neurological disease
  • Metabolic or genetic diseases

General Physical Examination:

  1. Obvious deformities
  2. Dysmorphism?
  3. Head and neck: Microcephaly/ Hydrocephalus
  4. Nutritional wasting?
  5. Systems: Cardiovascular findings
  6. Liver enlargement
  7. Splenomegaly
  8. Skeletal and spine abnormalities

Neurological Examination:

  • Muscles: Atrophy/ Hypertrophy
  • Cranial nerve observation
    • Ptosis
    • Facial expression
    • Extraocular movements
    • Muscles of facial expression
    • Fasciculations of tongue
  • Tone: Hypotonic/ Hypertonic
  • Posture
  • Horizontal and vertical suspension
  • Scissoring or spasticity
  • Power
  • Reduced/ Normal
  • Proximal versus distal
  • Reflexes: Hypotonia/ Hyperactive/ Clonus

The following questions can be asked following the presentation.

Investigations:

  1. Thyroid functions- TSH, free T4,
  2. Electrolytes (including calcium)
  3. Imaging- CT/MRI head
  4. EEG
  5. Karyotype
  6. Metabolic Disease Suspected:
    1. Urine and serum amino acids
    2. Urine organic acids
    3. Blood gas
    4. Serum ammonia
  7. Liver function tests
  8. Creatine kinase

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