Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns

OBJECTIVE

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.

METHODS

This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns ≥ 34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.

RESULTS

A total of 1010 neonates were enrolled. The mean AF size was 2.23 ± 0.52 cm (mean ± SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F = 31.30) (P < 0.001) and also by increasing birth weight (F = 20.34) (P < 0.001). There was no significant difference in the mean AF size between males; 2.21 ± 0.54 cm and females; 2.25 ± 0.55 cm (mean ± SD) (P = 0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r) = 0.985. In small for gestational age neonates the AF was larger, 2.27 ± 0.55 (mean ± SD) and a strong correlation between birth weight z-score and AF size was noted (r = 1.012).

CONCLUSIONS

The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23 ± 0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.

Cord serum 25-hydroxyvitamin D is not associated with cranial anthropometrics in infants up to 6 months of age. An Odense Child Cohort study

Skull changes are poorly described in vitamin D insufficiency [serum 25-hydroxyvitamin D (s-25(OH)D) 25-50 nmol/L]. We aimed to investigate factors associated with cranial anthropometrics in infants, especially s-25(OH)D. In infants 2.5-6 months old from the Odense Child Cohort, associations between cord and pregnancy s-25(OH)D and anterior fontanel area (n = 765), head circumference (HC, n = 1776) and head shape (n = 1527) were investigated along with other factors. Age was corrected for preterm birth. The mean (SD) s-25(OH)D in early pregnancy was 65.97 (21.33) nmol/L; late pregnancy 78.61 (27.18) nmol/L; and cord 47.1 (21.7) nmol/L. At median (IQR) age 3.7 (2.5-5.9) months, the fontanel area was 225 (0-1690) mm², and mean (SD) HC was 41.5 (1.5) cm. Asymmetric/flat head shape was present in 846 infants (55.3%). No associations were found between cord, early or late pregnancy s-25(OH)D and any cranial measure by univariate or adjusted analysis. Among significant, independent associations in multivariate analysis, fontanel area was associated inversely with gestational age (GA); HC was associated directly with GA, maternal pre-pregnancy overweight and caesarean section and inversely with smoking; and asymmetrical head shape showed a novel association with male sex: adjusted OR = 1.54 (95% CI 1.25; 1.89), p < 0.001. Other associations with asymmetrical head shape included parity 3+, gestational age and maternal age 30+ years (all protective). In conclusion, neither pregnancy nor cord s-25(OH)D was associated with fontanel size, HC or asymmetrical head shape despite a high prevalence of cord s-25(OH)D < 50 nmol/L. Lower GA was associated with larger fontanel size, lower HC and asymmetrical head shape, and boys more frequently had asymmetrical head shape, probably due to heavier heads.

Anterior fontanelle size among term neonates on the first day of life born at University of Gondar Hospital, Northwest Ethiopia

Background

Anterior fontanelle is the largest, prominent and most important fontanelle, which is used for clinical evaluation. It is mainly characterized by its size and shape variation and is possibly influenced by gender, race and genetics. Understanding the variation of anterior fontanelle is used for recognition of different medical disorders and abnormal skeletal morphogenesis.

Objective

To determine the mean size of anterior fontanelle among term neonates on the first day of life born at University of Gondar Hospital, Gondar Town, Northwest Ethiopia, 2018.

Methods

Descriptive cross sectional study design was undertaken in 384 term and apparently healthy neonates, using standard methods. Descriptive analysis, student t-test, one way ANOVA and Pearson correlation coefficient were implemented.

Results

In this study, the mean size of anterior fontanelle in term neonates was 3.00 ± 0.62 cm (range 1.70–5.50 cm). The mean size of anterior fontanelle was 3.10 ± 0.66 cm for males, and 2.88 ± 0.57 cm for females. There was statistically significant difference in anterior fontanelle size in neonates of different genders (p<0.001), mode of delivery (p<0.001) and duration of labour (p = 0.006). However, the size of anterior fontanelle was not significantly affected by the birth order, onset of labour and socio-demographic variables of the mother except occupation of the mother (p = 0.01). There was a significant positive correlation between the mean size of anterior fontanelle with birth weight (r = 0.11; p = 0.04) and head circumference (r = 0.17; p = 0.001).

Conclusions

At term, male neonates had significantly larger anterior fontanelle than female neonates and anterior fontanelle size has a direct relationship with birth weight and head circumference.

EEG in neonates: Forward modeling and sensitivity analysis with respect to variations of the conductivity

The paper is devoted to the analysis of electroencephalography (EEG) in neonates. The goal is to investigate the impact of fontanels on EEG measurements, i.e. on the values of the electric potential on the scalp. In order to answer this clinical issue, a complete mathematical study (modeling, existence and uniqueness result, realistic simulations) is carried out. A model for the forward problem in EEG source localization is proposed. The model is able to take into account the presence and ossification process of fontanels which are characterized by a variable conductivity. From a mathematical point of view, the model consists in solving an elliptic problem with a singular source term in an inhomogeneous medium. A subtraction approach is used to deal with the singularity in the source term, and existence and uniqueness results are proved for the continuous problem. Discretization is performed with 3D Finite Elements of type P1 and error estimates are proved in the energy norm (H¹-norm). Numerical simulations for a three-layer spherical model as well as for a realistic neonatal head model including or not the fontanels have been obtained and corroborate the theoretical results. A mathematical tool related to the concept of Gâteau derivatives is introduced which is able to measure the sensitivity of the electric potential with respect to small variations in the fontanel conductivity. This study attests that the presence of fontanels in neonates does have an impact on EEG measurements.

[Changes of anterior fontanel size in children aged 0 - 2 years]

OBJECTIVE

To study the development of anterior fontanel(AF) in children less than 2 years of age.

METHOD

The size of AF of the children under 2 years of age was measured. The criteria were: (1) All the children were singletons and term (37 weeks ≤ gestational age ≤ 40 weeks) at birth, birth weight > 2500 g. (3) Those with intracranial diseases (included trauma and asphyxia) and scalp hematoma were ruled out. (3) Healthy children (without intracranial disease, growth retardation, congenital syndrome or bone metabolic diseases such as rickets).

RESULT

(1) The mean value of AF in neonates was 1.5 (0.3 - 2.5) cm, and the average of the AF at 1 month after birth was 2.2 cm, which was the largest one. The size of AF was 1.0 (0.3 - 2.0) cm at age 12 months, and 0.5 (0.3 - 0.7) cm at 24 months. (2) The percentage for the closure of the AF was 3% at 6 months, 26.5% at 12 months, and 93.0% at 24 months. (3) There were no gender differences in the size of the AF (P > 0.05). And the size of AF was not correlated with the development levels of weight, length, and head circumference (P > 0.05).

CONCLUSION

(1) The size of AF at 1 month was maximum (2.2 cm), and then decreased by years. The AF was almost closed (93%) at 24 months. (2) There were no gender differences in anterior fontanel (P > 0.05). The size of AF was not correlated with the growth of weight, length, and head circumferences (P > 0.05). (3) The fontanel dimensions should be represented by oblique diameters of the fontanel in clinical pediatrics. (4) The AF closure time needs to be further evaluated in normal children.

Anterior fontanelle size in healthy Iranian neonates on the first day of life

There is limited data in the literature on the normal size of the anterior fontanelle. This cross- sectional study was to determine normal values of anterior fontanelle size on the first day of life, using standard methods. Anterior fontanelle size was measured in 400 term and healthy neonates delivered at the Shariati Hospital, Tehran, Iran. Examination included assessment of head circumference, anterior fontanelle size, weight, length. Type of delivery was also recorded. The mean size of anterior fontanelle was 25.34 ± 13.27 mm, and it was established in both genders, 26.70 ± 13.19 mm in boys, and 23.67 ± 13.20mm in girls. A significant difference between the mean anterior fontanelle size in boys and girls was found (P=0.023). There was no significant difference in anterior fontanelle size between the infants born with a normal vaginal delivery and those with cesarean-section (P=0.08). There was found a significant negative correlation between the mean size of anterior fontanelle size with both weight and height (P<0.05). No significant correlation was found between mean size of anterior fontanelle and head circumference or with gestational age of infant (P≥0.05). Our results proved possible to define a references range and centile chart. The method used is simple and accurate and easy used in the routine neonatal examination.

Brain herniation in a neonate

Brain herniation is generally thought to be unlikely to occur in newborns due to the presence of the patent fontanelles and cranial sutures. A review of the literature published from 1993 to 2008 via MEDLINE search revealed no reports on neonatal brain herniation from intracranial tumour. We report a preterm Malay male infant born via elective Caesarean section for antenatally diagnosed intracerebral tumour, which subsequently developed herniation. Cerebral magnetic resonance imaging showed features that were compatible with a large complex intracranial tumour causing mass effect and gross hydrocephalus. Tumour excision was scheduled when the infant was two weeks old. Unfortunately, on the morning of the surgery, he developed signs of brain herniation and had profuse tumour haemorrhage during the attempted excision. Histopathological examination revealed an embryonal tumour, possibly an atypical rhabdoid/teratoid tumour. This case illustrates that intracranial tumours in newborns can herniate and should therefore be closely monitored.

[Applied anatomy of the fontanelles]

OBJECTIVE

To make a description of the anatomy of fontanelles and to update what is currently known about their applications.

METHOD

7 cadaveric heads, 2 dry skulls and 2 frontal bones of foetus were used, and 48 anterior fontanelles from paediatric patients with or without associated pathology were examined. Surgical cases and neurosonography were also used. All the structures were measured and subsequently analysed.

RESULTS

The size, structure and limits of the fontanelles were evidenced in the cadaveric head and skulls, as well as the evaluation of paediatric patients and the size of their fontanelles in different pathologies.

CONCLUSION

Owing to their anatomical characteristics, fontanelles are a true window to the inside of the skull, which determines their multiple clinical and surgical applications.

[Effects of calcium and vitamin D supplementation on bone specific alkaline during pregnancy lactation and infant]

OBJECTIVE

To investigate the effect of calcium and vitamin D supplementation during pregnancy, lactation and infants on bone development of infant.

METHODS

1176 health infants aged 42-365 days and their mothers were recruited as subjects at Pediatric Department in Beijing Obstetrics and Gynecology Hospital during November 2006 to January 2008. Retrospective questionnaire was asked about calcium and vitamin D supplementation during pregnancy, lactation and infant. Blood bone-specific alkaline (BAD) and fontanel anterior (FA) of infant were measured. Chi2 test and logistic regression were used to analyze the research data.

RESULTS

The chi2 test result showed that maternal supplementation with Ca and vitamin D during breastfeeding could decrease infant BAP significantly (P = 0.018), while supplementation during pregnancy could not (P = 0.154). The logistic regression result showed that infant supplementation with Ca and Vitamin D could decrease infant BAP significantly (P = 0.000), while infant feeding methods could not (P > 0.05). The FA size of infants aged < or =42 days had significant negative relationship with BAP (P = 0.017), and no relationship with Ca and vitmin D supplementation during pregnancy.

CONCLUSION

Supplementation with Ca and vitamin D of mother during lactation and infant could significantly decrease infant BAD. The FA size could not indicate the infant calcium status.