Down’s Syndrome and Craniovertebral Instability: Topic Review and Treatment Recommendations

Brockmeyer, Douglas L.

doi:10.3126/njn.v2i1.19995

Cited by 15 publications

(26 citation statements)

References 24 publications

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“…Increased intracranial pressure (of any extent) has particular implications for perioperative care and should be noted in the history. For children at risk for cervical spine instability (eg, Down syndrome, 25 mucopolysaccharidoses, 26 severe Ehlers-Danlos syndrome), results of cervical spine radiographs or history of symptomatic instability should be clearly identified for the surgeon and anesthesiologist. Radiographic screening does not predict risk of cervical instability 27 in Down syndrome.…”

Section: Central Nervous Systemmentioning

confidence: 99%

The Pediatrician’s Role in the Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia

Goldschneider¹,

Cravero²,

Anderson³

et al. 2014

Pediatrics

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Pediatricians play a key role in helping prepare patients and families for anesthesia and surgery. The questions to be answered by the pediatrician fall into 2 categories. The first involves preparation: is the patient in optimal medical condition for surgery, and are the patient and family emotionally and cognitively ready for surgery? The second category concerns logistics: what communication and organizational needs are necessary to enable safe passage through the perioperative process? This revised statement updates the recommendations for the pediatrician' s role in the preoperative preparation of patients. Pediatrics 2014;134:634-641 INTRODUCTIONPrimary care providers, including pediatricians, are frequently called on to evaluate and psychologically prepare patients and families before a child undergoes a procedure requiring anesthesia or sedation. This policy statement identifies that primary care provider' s preoperative goals of care are as follows: to clearly define the child' s medical issue; to delineate the physiologic effects and limitations imposed by each condition; and to optimize the management of any comorbid conditions. Furthermore, the policy recommends that pediatricians facilitate essential communication about the historical, physical, and laboratory findings in children with unusual or complex medical histories with the anesthesiologist and/or surgeon to ensure safe perioperative care.The objectives of the present statement were twofold:1. to describe to pediatricians the issues of concern to anesthesiologists and surgeons to improve the effectiveness of medical consultations in preparing pediatric patients and families for the perioperative period; and 2. to present information that will encourage and facilitate communication among surgeons, anesthesiologists, medical subspecialists, pediatricians, and other primary care providers.

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Section: Central Nervous Systemmentioning

confidence: 99%

The Pediatrician’s Role in the Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia

Goldschneider¹,

Cravero²,

Anderson³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…If no significant radiographic abnormalities are present, flexion and extension radiographs may be obtained before the patient is promptly referred. 23,62,63 • Measure TSH annually or sooner if child has symptoms that could be related to thyroid dysfunction.…”

Section: The Symptomatic Childmentioning

confidence: 99%

“…22 • Discuss with parents the importance of cervical spine-positioning precautions to avoid excessive extension or flexion to protect the cervical spine during any anesthetic, surgical, or radiographic procedure. 23,24 • Discuss efficacy of early intervention and availability of earlyintervention services and therapies in the community. Initiate referral as appropriate.…”

Section: Anticipatory Guidance Given At Least Once Between Birth and mentioning

confidence: 99%

Health Supervision for Children With Down Syndrome

2011

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These guidelines are designed to assist the pediatrician in caring for the child in whom a diagnosis of Down syndrome has been confirmed by chromosome analysis. Although a pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given a prenatal diagnosis of Down syndrome will be referred for review of the condition and the genetic counseling provided. Therefore, this report offers guidance for this situation as well.

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“…Most cases are asymptomatic [78,79]. No guidelines exist regarding the frequency of periodic screening or surgical indications, except for symptomatic children in whom atlantooccipital fusion is indicated [80,81]. Tredwell and colleagues [29] believe that treatment plans should depend on the amount of space available for the cord rather than on absolute values of displacement.…”

Section: Down Syndromementioning

confidence: 99%

Pediatric cervical spine instability

Ghanem

Hage

Rachkidi

et al. 2008

Journal of Children's Orthopaedics

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Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.

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Down’s Syndrome and Craniovertebral Instability: Topic Review and Treatment Recommendations

Cited by 15 publications

References 24 publications

The Pediatrician’s Role in the Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia

The Pediatrician’s Role in the Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia

Health Supervision for Children With Down Syndrome

Pediatric cervical spine instability

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