Neonatal hypertonia – a diagnostic challenge

Abstract

In comparison to hypotonia, hypertonia is less commonly expressed in the neonatal period. The scientific literature on the causes of neonatal hypertonia is scant, with no suggested diagnostic algorithm easily available to clinicians. Aetiologies include conditions affecting the central nervous system and spine, and rare peripheral neuromuscular disorders leading to hypertonia. Aetiology onset may be antepartum, peripartum with either transient hypertonia or persistent hypertonia which may appear later, or from a postnatal event/disease. This review discusses neonatal hypertonia and a diagnostic approach to neonatal hypertonia is suggested.

Heart rate variability alterations in infants with spontaneous hypertonia

“…3 Although cerebral palsy is the most common cause of hypertonia in children, 3 a significant number of infants display spontaneous hypertonia in the absence of pyramidal neuron lesions. 4 The precise mechanisms underpinning development of spontaneous hypertonia in newborns is incompletely understood, however it has been proposed that this condition is related to poor maternal health (i.e., drug abuse, metabolic disorders, trauma) during pregnancy. 4 In addition to abnormal control of movement, several studies suggest that hypertonia is associated with abnormal function of the autonomic nervous system.…”

“…4 The precise mechanisms underpinning development of spontaneous hypertonia in newborns is incompletely understood, however it has been proposed that this condition is related to poor maternal health (i.e., drug abuse, metabolic disorders, trauma) during pregnancy. 4 In addition to abnormal control of movement, several studies suggest that hypertonia is associated with abnormal function of the autonomic nervous system. 5,6 Indeed, abnormal autonomic function is observed in clinically distinct hypertonia populations.…”

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

“…Hypertonia following intrapartum HI is generally anticipated to be expressed after 5–7 days of life. Earlier expression of hypertonia alternatively reflects chronic acquired ( 149 , 150 ) or genetic disorders ( 151 ), once acute etiologies such as infection, drug withdrawal and intracranial hemorrhage are eliminated as etiologies. In the absence of these acute scenarios, hypertonia can be associated with the over-expression of subcorticospinal pathways after significant chronic or subacute cortical injury or maldevelopment.…”

The Role of BRCA1 and BRCA2 Genes in the Appearance of Pediatric and Adolescent Disorders

“…Also noted frequent manifestations of spontaneous apnea and bradycardia leading to cardiopulmonary dysfunction. Subjects identified a novel homozygous mutation of c.638_639insA of BRCA1 gene associated with severe corticobasal decomposition [15,16]. Therefore speculated that the instability and dysfunction of BRCA1 protein is responsible for the occurrence of catastrophic epilepsy and neuronal atrophy [15,16].…”

“…Therefore speculated that the instability and dysfunction of BRCA1 protein is responsible for the occurrence of catastrophic epilepsy and neuronal atrophy [15,16]. Additionally two pups from Japan revealed progressive cerebral degeneration atrophy of the cerebellum and delayed myelination of white brain tissue [15,16].…”