Issue #20: When a pit is not just a pit....
Closed spinal defects and their skin findings
How many times have you been examining a baby and you find something slightly abnormal in the lower back area? Maybe it’s a birth-mark, a lump, a hairy patch or, as we commonly see, a dimple. What would you be concerned about? And what would you do about it?
We covered all of this in our last video. Watch it here, if you haven’t seen it yet.
Let’s start with our possible concerns. As you probably already know: skin markings may indicate an underlying abnormality of the spinal cord or its nerve roots. Tissue may attach to the spinal cord, limiting its mobility, causing what we call Tethered Cord Syndrome (TCS).
Initially a baby may have no signs of TCS, but as the infant grows, the ‘stuck’ spinal cord will become increasingly damaged secondary to pressure and ischemia . The growing child may suffer from the following types of symptoms:
Numbness, tingling, or burning sensations in the legs, feet, or buttocks
Weakness or paralysis in the lower extremities
Foot deformities
Difficulty walking or standing
Loss of bladder or bowel control
Scoliosis
If these symptoms progress, eventually they become irreversible. So- it’s important we catch these diagnoses before it’s too late.
Luckily- the cutaneous stigmata give us good clues as to what’s happening beneath the skin- AND! depending on WHICH skin findings the baby has, there is a higher or lower chance of Tethered Cord Syndrome.
Check out this table below:
The risk group will determine which imaging you should obtain:
High risk: obtain an MRI
Intermediate risk: Ultrasound of the spine (or straight to an MRI)
Low risk: No imaging! (Follow clinically)
Of note! An atypical dimple (>5mm, > 2.5 cms from the anus) needs imaging, whereas a simple dimple (I love that phrase!) doesn’t need anything!
Check out these two references for more information:
Neural Tube Dysraphisms: Review of Cutaneous Markers and Imaging
Incidence of Occult Spinal Dysraphisms Among Infants With Cutaneous Stigmata and Proportion Managed With Neurosurgery (A Systematic Review and Meta-analysis)
Our PDF summary of the video:
And a few questions:
And the rest:
This NYT article written by a volunteer cuddler on her bond with a withdrawal baby is such a great description of the NICU.
Are you all reading Neonatal Research? Because you should be! Dr. Barrington examines recent articles- explaining the studies themselves and then putting them into a broader context (including how the research affects our babies at the bedside). Everything he writes is just so informative!
And again- if you’d like to choose which videos we watch next (you’re going to be so happy with recent member choices!), or you’d like a neonatal tip a week, live chats and zoom sessions, PDF worksheets (and more!) then join our lovely community here: JOIN
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Seriously, is it Spring yet? We’re done with this weather! Remember to check out our Amazon storefront! We added reference and non-fiction books as well as a few other NICU friendly items. If you purchase anything through the links, all commissions will go to a neonatal charity. (So have at it!)
We hope you’re enjoying this newsletter as much as we enjoy writing it. We’d love to hear your thoughts either way…(Podcasts you’re listening to? Items you can’t live without? Want to be on our 5 questions and answers segment?!)
Stay healthy, and we’ll be back in your inboxes in 2 weeks,
Tala and Arianna
P.S Our opinions are our own and do not represent the hospitals or practices we work for. This newsletter is intended for educational/entertainment purposes only and is in no way a replacement for medical advice.
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