Community paediatrics Flashcards
What is cerebral palsy?
Group of permanent non progressing motor disorders affecting muscle tone, posture and movement.
Is acquired due to insult to developing brain in prenatal, perinatal or postnatal early infancy.
What are the RF of cerebral palsy?
- Low birth weight and prematurity
- Perinatal hypoxic ischaemic injury
- Congenital abnormalities
- Multiple births
- Stroke and intracerebral haemorrhage
- Intrauterine infection
- Maternal factors - seizure disorder, thyroid
- Genetic factors
- Postnatal event eg. sepsis, trauma, kernicterus
How does prematurity contribute to CP development?
Cerebral injury due to under perfusion can cause periventricular leukomalacia = damage to white matter, this area normally controls motor func and tone
How can perinatal hypoxic ischaemic injury cause CP?
Causes - placental abruption, ruptured uterus, amniotic fluid embolus
Hypoxic ischaemic event = neonatal encephalopathy:
- Reduced conc
- Seizures
- Tone and reflex abnorm
- Apnoea and aspiration
these infants may develop CP.
What are some early features of CP?
- Abnormal movement - paucity, asymmetrical, fidgety
- Abnormal tone - floppy/hypotonic, spastiticty/stiff, dystonia = abnormal muscle contraction
- Retained or exaggerated developmental reflexes
- Feeding difficulties
Red flag milestones - not sitting by 8m, not walking by 18m, early hand preference
What are the different subtypes of CP?
Spastic - features of upper motor neurone weakness - increased tone, weak, hyperreflexia, clonus (most common type)
Dyskinetic - involuntary movement - choreoathetosis, dystonia
Ataxic - abnormal coordination, rare
What are some conditions associated w CP?
- ID
- Pain
- Visual impairment
- Epilepsy
- Speech and lang disorders
- Bladder control problems
- Drooling
- Feeding difficulties
What are the types of spastic weakness in CP?
Spastic diplegia - lower limbs predominately affected, scissoring gait, hips flexed and adducted, int rotation
Spastic hemiplegia - only on side affected, arm more than leg, shoulder adducted, elbow flexed, hand closed and wrist flexed
Spastic quadriplegia - all limbs affected, severely handicapped
Chorea vs athetosis
Chorea - rapid, irreg, unpredictable muscle contractions - face, bulbar muscles, proximal muscles
Athetosis - slow, smooth, writhing movements - distal muscles
What is the medical management of CP?
- Anti cholinergics for drooling
- Laxatives eg. movicol for constipation
- PEG for nutrition
- Anti epileptics
- Anti spasmodics for spasticity eg. baclofen, botox injections
- Analgesia
What is the surgical management for CP?
For sx that don’t respond to conservative and medical therapyies.
Ortho - hip dysplasia, severe contractures
ENT - disabling drooling
What is the prognosis of CP?
- Non progressive
- Life expectancy reduced, more severe = shorter life expectancy
- Aspiration pneumonia is most common cause of death
- If child can’t sit or roll at 2 years old, unlikely to walk unaided
What are different types of developmental delay?
Develop arrest - child develops normally and then can’t develop new skills
Develop regression - develops normally and then looses prev acquired skills - red flag
Neurodevelop disorder - deficits in develop and impairment in normal func eg. ADHD, ASD
Learning disability - reduced intellectual ability in all aspects, sig impairment in social or adaptive func
Learning difficulty - specific problem eg. dyslexia, intellectual ability not affected
What are some antenatal causes of develop delay?
- Genetic disorders - Down’s, Fragile X syndrome, Chromosomal abnormalities
- Structural brain disorders - microcephaly, hydrocephalus
- Vascular
- Infections - rubella, CMV, toxoplasmosis
- Drugs and toxins
What are some perinatal causes of develop delay?
- Prematurity
- FGR
- Intraventricular haemorrhage
- Perinatal asphyxia - hypoxic ischaemic encephalopathy
- Hypoglycaemia
What are some post natal causes of develop delay?
- Anoxia - suffocation, near drowning, seizures
- Trauma
- Malnutrition
- Metabolic - electrolyte disturb, hypoglycaemia
