Anemia of Prematurity - Portal Neonatal

An experienced pediatrician or surgeon should examine any neonate with cutaneous stigmata on
the back around the gluteus. A good rule of thumb is that a lesion (eg, pit, tract) below the gluteal
crease is often a pilonidal sinus and needs no further evaluation. Those tracts, pits, or lesions
above the gluteal fold should be evaluated with further study.
Lesions that are questionable can be scanned with ultrasound in a neonate or with MRI in an older
child. The ultrasound or MRI delineates the presence or absence of a tethered cord or other spinal
anomaly. Plain radiology can reveal a panoply of anomalies, such as fused vertebrae, midline
defects, bony spurs, or abnormal laminae. An MRI often is useful in evaluating for a split cord
malformation (ie, diastematomyelia), in which a bony spur splits the spinal cord, or a duplication of
the spinal cord and nerve roots (diplomyelia). More commonly, the neurosurgeon is searching for
tethering of the spinal cord by a sinus tract or thickened filum that can cause traction on the spinal
cord with subsequent neurologic deficits as the child grows.
A growing body of evidence indicates that the surgical repair of these lesions is more effectively
performed in a prophylactic fashion. Once the patient experiences a significant neurologic deficit
such as a neurogenic bladder or leg weakness from these occult spinal lesions, the surgical
remedy may not return the patient to previous neurologic status.
Signs and symptoms of occult spinal disorders in children include the following:
• Radiologic signs
o Lamina defects
o Hemivertebrae
o Scoliosis
o Widening of interpedicular distance
o Butterfly vertebrae
• Cutaneous stigmata
o Capillary hemangioma
o Caudal appendage
o Dermal sinus
o Hypertrichosis
• Orthopedic findings
o Extremity asymmetry
o Foot deformities
• Neurological problems
o Weakness of leg or legs
o Leg atrophy or asymmetry
o Loss of sensation, painless sores
o Hyperreflexia
o Unusual back pain
o Abnormal gait
o Radiculopathy
• Urologic problems
o Neurogenic bladder
o Incontinence
Cranium bifida
Several types of midline skull defects are classified under this term, ranging from simple, with
minimal clinical significance, to serious life-threatening conditions. The most benign type of cranium
bifidum occultum is the persistent parietal foramina or persistent wide fontanelle. The parietal
foramina can be transmitted as an autosomal dominant trait via a gene located on the short arm of
chromosome 11. The condition is sometimes called "Caitlin marks," after the family for which it was
described. Both parietal foramina and a persistent anterior fontanelle are generally asymptomatic
and a pediatric neurosurgeon may be asked to evaluate the child for skull fracture,
craniosynostosis, or some other reason related to these findings. The best management is
observation over time, as these skull defects often close over time.