Anterior Fontanel Size Among Term Newborns: A Systematic Review and Meta-Analysis

Ultrasonographic Measurement of Anterior Fontanelle Size in Infants with Deformational Plagiocephaly

Background/Objectives: We aimed to investigate the relationship between deformational plagiocephaly (DP) severity and anterior fontanelle size and to explore the connection between fontanelle size and developmental delay. Methods: We enrolled 189 (122 boys and 67 girls; mean corrected age, 119.79 days) of the 256 infants who visited our clinic for plagiocephaly between March 2022 and June 2023. This study analyzed the correlation between cranial vault asymmetry (CVA) and anterior fontanelle size as measured using skull anteroposterior (AP) radiography and ultrasonography. The severity of DP was graded from minimal to severe based on the Argenta classification. Infants were grouped according to CVA severity as follows: Group 1 (CVA ≤ 5 mm), Group 2 (5 mm < CVA < 10 mm), and Group 3 (CVA ≥ 10 mm). Additionally, 40 infants underwent the Denver Developmental Screening Test II (DDST-II) for neurodevelopmental delays and were divided into groups based on the presence or absence of developmental delays for fontanelle size comparison. Results: Age showed a significant negative correlation with fontanelle size (correlation coefficient -0.234, p < 0.05), indicating that fontanelle size decreases as infants age. No significant differences in fontanelle size were observed among the three CVA groups (p = 0.074) or between the developmentally delayed and non-delayed groups (p = 0.09). This study found no correlation between CVA and fontanelle size or between fontanelle size and developmental delay. Conclusions: The findings show that, while anterior fontanelle size decreased with age, there was no significant correlation between the fontanelle size and the severity of deformational plagiocephaly or developmental delays.

High-Resolution Ultrasound Platform for Infant Meningitis Detection: An In Vitro Demonstration

Infant meningitis remains a severe burden on global health, particularly for young infants. Traditional ultrasound imaging techniques are limited in spatial resolution to visualize white blood cells (WBCs) in the cerebrospinal fluid (CSF), which is considered a well-established marker for meningitis detection. This work presents a novel platform that uses high-resolution ultrasound to detect the backscatter signals from microscopic CSF WBCs through the anterior fontanelle of neonates and young infants. The whole system was built around a custom probe that allows for a 20 MHz focused transducer to be mechanically controlled to map the area of interest in the CSF. Data processing can be performed internally in the device without the need to extract the images for further analysis. The in vitro feasibility of the proposed solution was evaluated in imaging 7 μm particle suspensions at different concentrations relevant to meningitis diagnosis ranging from 7- to 646-particles (pp)/μL. The experimental tests were conducted from a simple setup using a sample container to a more realistic setup based on an anatomical phantom of the neonatal head. The results show high-quality images, where 7 μm particles can be resolved for the different concentrations.

Determination of Anterior Fontanelle Size among Apparently Healthy Term Newborns in North Central Nigeria

BACKGROUND

Anterior fontanelles (AFs) of healthy newborn infants vary widely in size, this being a function of race, geographical location, gender, birth weight, mode of delivery and gestation. Abnormal variations in AF size portend a serious pathology of the cranium or intracranial structures. The established reference value for normal AF size is, therefore, an essential diagnostic tool. This study was conducted to determine the mean AF size and factors that are associated with its variability among apparently healthy term neonates in Lokoja, North Central Nigeria.

METHODS

AF size was measured in 200 healthy inborn term neonates between 24 and 48 h post-delivery using a modified version of Mattur's method. Other parameters measured were head circumference, birth weight and length. Relevant statistical methods were used for data analysis, and P < 0.05 at a confidence interval of 95% was considered statistically significant.

RESULTS

Eighty-six (43%) of the babies were males, and the mean birth weight and gestation were 3.09 (0.37) kg and 38.8 (1.2) weeks, respectively. Majority (72%) were delivered spontaneously per vagina. The mean (± SD) AF size of the study neonates was 2.62 (0.72) cm (2.53 [0.61] cm in males and 2.69 [0.79] cm in females). Neither gender nor mode of delivery affected AF size significantly. There was no significant correlation between AF size and occipitofrontal circumference.

CONCLUSION

AF size for term babies in our hospital differs from AF sizes reported from other parts of the world, further reiterating the utility of local/regional neonatal AF reference values.

Hot fomentation of newborn fontanelles as an indigenous practice in Ghana: implications for policy and integrated community-based health care in Covid-19 pandemic and beyond

OBJECTIVE

African newborns undergo numerous traditional and religious practices ranging from fontanelle fomentation to total head shaving, scalp molding, skin scarification and ano-genital irrigation which can negatively impact the health of neonates. Hot fomentation of fontanelles has been a predominant indigenous home-based postnatal practice in Ghana and among Africans in the diaspora. Mobility restrictions during the Covid-19 pandemic has impacted direct access to facility-based care as well as home care. The flourishing of newborn traditional practices among African populations during this Covid-19 pandemic offers opportunities to rethink the provision of family healthcare support for newborns during the ongoing pandemic and beyond. Hence, the aim of this critical review was to examine and describe a common indigenous practice-hot fontanelle fomentation to inform home birth support, discharge planning, and the delivery of optimal home-based care support.

STUDY DESIGN

This study is a review of literature on hot fomentation of newborn fontanelles.

METHODS

Literature search in CINAHL, PubMed, African Index Medicus and Scopus, was conducted and evidence synthesised from articles ranging from 1983-2022. Sixty articles were reviewed; however, 10 manuscripts were excluded prior to screening. The other 19 were exempted because they were either below 1983 or were not the best fit for the study purpose. In all, 31 studies were included in the study. The study was guided by Madeleine Leininger's Culture Care Diversity and Universality care theory.

RESULTS

The current study identifies hot fomentation of newborn fontanelles practices in Ghana, the description of hot fomentation practices and the dangers associated with it. The findings and suggested ways to help overcome this challenge.

CONCLUSION

There are several neonatal indigenous practices including fontanelle fomentation which pose threat to the health of the neonate as discussed in this study. Future research needs to investigate innovative ways of fontanelle fomentation where necessary instead of the use of hot water by mothers, especially in this Covid-19 pandemic where health and mobility restrictions impact physical access to timely health care. This research will help educate mothers about the dangers of fontanel fomentation and reduce the practice, especially in rural areas of developing countries. This could help reduce neonatal mortality and unnecessary healthcare costs.