Frequency and Causes of hypotonia in neonatal period

Hypotonia: A Symptom of Brain Diseases

Hypotonia is a condition characterized by decreased muscle tone and muscle weakness. It is a symptom of brain diseases that affect motor nerve control. Central hypotonia is caused by the central nervous system, whereas peripheral hypotonia is caused by the spinal cord, peripheral nerves, or skeletal muscles. Hypotonia caused by cerebellar dysfunction or motor neuron illness can be progressive, culminating in progressive hypotonia (Patricia, Sylvia, Adela, Cristina, Mihaela, Smaranda, & Mihaela, 2017).

Aeon's Increasing Hypotonia

Aeon, a seven-month-old male newborn, now has increasing hypotonia. On 10/5/2017, he was admitted to the hospital via a pediatric unit at the age of 6 months. He had presented with respiratory distress having been diagnosed with hypotonia two months ago. The mother reported of some chocking and coughing after feeding him during the previous day. The baby was experiencing little breathes with the belly rising and falling with respirations. He had intermittent constipation that is hard stooling at times. The baby was put on respiratory support while other investigations were being completed.

The Background and Examination Findings

The baby was born through spontaneous vaginal delivery (SVD) at term. He had normal weight with Apgar score at normal range. The mother is suffering from psychiatric illness and baby had been neglected to some extent. Even with the severity of the symptoms, the baby was delayed from getting medical attention. However, the baby had completed all the immunization as required. Upon examination and investigation did including imaging, there was an indication of decreasing atelectasis at the right base of the lung, moderate gaseous distention of the stomach, streaky bilateral perihilar opacities of the lungs, and enteric tube side portal terminating in the distal esophagus.

Diagnosis and Treatment

The baby had decreased neurological findings that is, decreased reflexes, muscular dystrophies, hypotonia in all extremities, and had reduced head movement. He was diagnosed to have Spinal Muscular Atrophy (SMA) type 1. He underwent tracheostomy with a gastric tube placement, and he was put on the mechanical ventilator. He is currently in acute care relying on long-term mechanical ventilation. He is also recovering from the surgery with regular tracheostomy site cleaning and changing. He is also in a gradual transition to bolus and weaning sedation. He is equally on prescribed medicine to manage this condition.

Summary of Hospitalization

The patient has been admitted for over one month with different types of medical care being offered. The baby was born in the hospital and together with the mother were discharged without any complication cases arising. After which he was regularly seen by a pediatric neurologist at the pediatrics clinic. He was taken to some hospital clinical follow-ups and mother reports of 2 to 4 months immunization in hospital.

Course of Hospitalization

The patient was admitted to the emergency pediatric ward. He was hospitalized with time as assessments were being conducted. It required numerous lab investigations and radiological imaging to determine the correct diagnosis. He was taken to the lab for blood, enzymatic and hormone tests. This processes took time as he remained under medical care with medications (Griffon, et al., 2016).

Surgical Intervention and Critical Care

After identifying the primary diagnosis and the course of action were determined, the patient was taken to the surgical ward. The invasive procedure had to take place for the patient to be able to breathe efficiently. He was admitted to the surgical unit awaiting surgical operation. He was taken into theatre room for the procedure and taken back after it was all done.

The patient required progressive critical care to increase his chances of survival. For this reason, he was hospitalized in a critical care unit (ICU). This could provide advanced respiratory support and post-operative monitoring. Specialists including ICU team is providing direct patient care at the bedside, reviewing and managing any arising complications. He could later be either transferred to the medical-surgical unit as he recovers from that invasive procedure. The period he still will be staying in the hospital is not predetermined depending on the quickness to recovery.

Disease Management Program

Summary of the disease management program

This case was taken as an emergency regarding its severity. Since the chief complains was respiratory distress the medical management was focused on supporting respiration, providing mechanisms for ventilation first. Therefore respiratory support, tracheostomy, and placement of gastric tubes were done. It required a different kind of medications, for instance, he was on acetaminophen and ibuprofen to manage pain. He was maintained nil per oral before surgery and fluids and nutrients were regulated.

Progressive hypotonia can be managed through different treatment programs. That include physiotherapy program, occupational therapy, support therapy and counseling programs. History taking and physical examination are key to the investigation of this condition. Physiotherapy involves taking the baby through light exercises to stimulate the muscles and the nervous coordination. It can include stretching and flexion of hands, legs, and thighs. Turning of the neck, and abdomen frequently can also help in controlling muscular atrophy (Cho, 2015).

Occupational therapy program involves engaging the infants in some activities such as grasping, holding and playing with items such as toys. Regular practicing of this program could reduce extreme symptoms of progressive hypotonic. Counseling program requires that parents are taken through a process that is psychological. This process brings about mental balance and initiates them to carry on with proper care to the hypotonic infants at home. This program promotes love towards affected patients. Children with hypotonia can also be referred to individualized programs such as speech and educational programs that can orient them mentally and improve nervous coordination.

Medically progressive hypotonia can be managed by treating its adverse symptoms or manifestation. For example, it may require surgical intervention to correct innervation of nerves. Since hypotonia troubles feeding by causing issues like impaired swallowing, there is a need for manipulations on the digestion system to deliver food to the stomach.

Outcome of Care

Outcome of hospitalization, outpatient care, rehab and home care

Hospitalization is accompanied by the provision of quality skilled services whose interventions are aimed at bringing solutions to problematic conditions. Hospitalization has a lower risk of infections and lowers chances to develop other major complication. With hospitalization, Aeon is doing better under continued management. Outpatient care provides patients with instant services with easy access. It provides assessment and diagnosis of conditions. It also provides pharmacy services for patients to pick their prescribed medications once they are diagnosed with a disease or discharged from wards. (SHAHABI, 2016)

Home care is the basis of all health outcomes. It creates an avenue to practice all the programs for managing progressive hypotonia. For example physiotherapy and occupational therapy. In this case, Aeon after being discharged from the hospital can get specialized care from his home. However, home care can get worse if the parents are not fully responsive. This baby's parents lacked insight and neglected him even when the symptoms were very severe. Rehabs are better in the provision of care because they possess trained professionals.

Comments and Observations

Summary comments and observations

The patient compliance with the medications and daily management is good. Taking all medication as required and welcoming every procedure. This has led to his positive response concerning wellbeing. He was presented as an emergency case with respiratory difficulty, but at this time the health interventions worked out. Now he is well recovering from an invasive operation, healing with daily changing and cleaning of tracheotomy site.

The therapeutic strategies involved in the management of this disease seem to be perfect and working out better. There was a proper investigation, diagnose and derive a mechanism to manage the disease. Through radiological imaging, surgery was made possible and correct prescription of the drugs has promoted prognosis (Nakashima, Miyake, Saitsu, Tanaka, & Kinoshita, 2014). The care given to the patient at all levels of hospitalization were good and professional. It is confirmed by lack of infections or complications.

Reference

Cho, A. K. (2015). Infant girl with progressive hypotonia.

Patricia, U., Sylvia, S., Adela, C. E., Cristina, S. P., Mihaela, B., Smaranda, A., ... & Mihaela, B. (2017). P36 Rare cause of progressive hypotonia in infancy.

Nakashima, C. O. Y. T. M., Miyake, N., Saitsu, N. M. H., Tanaka, C. O. F., & Kinoshita, Y. M. T. (2014). Erratum to: PIGN mutations cause congenital anomalies, developmental delay, hypotonia, epilepsy, and progressive cerebellar atrophy. neurogenetics, 15, 93.

Griffon, L., Amaddeo, A., Mortamet, G., Barnerias, C., Abadie, V., Olmo, J., ... & Fauroux, B. (2016). Sleep study as a diagnostic tool for unexplained respiratory failure in infants hospitalized in the PICU. Journal of Critical Care.

SHAHABI, S. N. (2016). Frequency and Causes of hypotonia in neonatal period with the gestational age of more than 36 weeks in NICU of Mofid children hospital during 2012-2014. Iranian Journal of Child Neurology, 11(1), 10989-10989.