Approach To A Floppy Infant 

Floppy Infants

A newborn who exhibits one or more of these traits is referred to as floppy. Weird alignments, such the frog-leg pose caused by hypotonia. More range of motion; Joint resistance to passive movement is reduced. Not enough spontaneous movements and differential degrees of postural lag

Ragged Doll And Frog Leg Posture

A floppy baby's body hangs in the "ragged doll posture," an arched position, when his tummy lifts him while he is face down. Head lag is the term for the backward hanging of the head observed in newborns when they are placed in the supine posture and lifted using their elbow during a traction test. In addition, there is no bending in the limbs or resistance in the joints.

Other Features

 Babies that are floppy and lie still may experience hair loss on the area of their scalp that is in regular touch with the crib sheet as well as flattening of the occiput. Their limbs hang limply, their heads dangle forward, and their shoulders slump when they are seated. The most accurate way to gauge a newborn's postural tone is through the traction response.

Also Read : Temperature Control In Neonates

When To Suspect And Evaluate                       

Parental Complaints 

• The complaints include 
• Slipping from their hands
• Immobile limbs when the child is awake
• Motor delays 
• Frequent falls in older children 

History

 Progression speed and age at onset. Recurrent pneumonia and feeding difficulties: signs of neuromuscular problem.

Reduced fetal movements and oligohydramnios in the antenatal period: indicators of SMA type 0 or 1. Family and prenatal history for a three-generation pedigree chart; isolated motor developmental delay: markers of neuromuscular or muscular disorder.

Examination 

• Examination of the face:
• Dysmorphism of the face may be a sign of congenital muscular dystrophy
• Myotonic dystrophy is suggested by an upper lip with an inverted V shape.
• Floppy traits along with normal attentiveness could be a sign of spinal muscular atrophy (SMA).
• Posture assessment: The kid is grasped from the axilla and its ability to slip through is examined.
• Denervation of muscles is indicated by tongue fasciculations.
• The degree of limb muscle weakening
• The degree of muscle weakness corresponding to hypotonia points to a neurological or muscular cause.
• Unequal muscle weakness points to disorders of the connective tissue, central nervous system, and metabolism or system.
• A pattern of fragility
• Prominent weakness in the proximal region denotes a muscle problem.
• With the exception of myotonic dystrophy, weakness that is noticeable in the distal section suggests neuropathic disease.
• Sensation and wasting
• Mild to moderate wasting in the absence of sensory loss is indicative of a muscle illness.
• Severe wasting along with loss of senses points to nerve illness.
• Reflexes of deep tendon
• Lesions in higher motor neurons are indicated by brisk DTRs.
• Lack of DTRs denotes a distal disease, usually affecting the muscles, nerves, or neuromuscular junctions.
• The force and impulsivity of breathing motions

Also Read: Skull Fractures And Traumatic Intracranial Hemorrhage

Causes Of Hypotonia

CNS-related factors: these result in either central or axial hypotonia; patients exhibit rapid deep tendon reflexes and cortical thumb presneces.
•Among the reasons are
• A hereditary brain illness
• Trauma; Cerebral dysgenesis; Inborn abnormalities in metabolism; Motor neuron diseases
• Patients exhibit widespread weakness that spares the sphincters, pelvis, face muscles, and diaphragm.
• DTRs are low or typical.
• For instance, SMA.
• Neuroopathies: These individuals exhibit a distal weakness accompanied by severe wasting and sensory loss.
Peripheral neuropathy is a common illustration. 

Neuromuscular junction deficiencies are responsible for fatigue and the involvement of the bulbar and ocular muscles. Two common examples of these anomalies are infantile botulism and myasthenia gravis.
• Defects in the muscles
• Proximal regions exhibit pronounced muscle weakness.
• Patients have significant joint contractures and inadequate DTRs. Muscular dystrophies, congenital myopathies, and metabolic myopathies are a few examples.
In roughly 60–70% of instances, central hypotonia is noted. It is the most widespread kind of hypotonia. • In hypotonia resulting from the central nervous system, hereditary factors predominate rather than acquired ones.

Causes Of Neonatal Floppiness                             

Causes of floppiness in neonates with normal appearance are 

• SMA type 1 
• Down syndrome 
• Congenital hypothyroidism 
• Congenital muscular dystrophy 
• Peripheral neuropathies

The causes of floppiness in sick neonates include :

• Maternal sedation, such as benzodiazepines
• Maternal magnesium sulfate administration 
• Perinatal asphyxia 
• IVH 
• Sepsis and meningitis
• Acute bilirubin encephalopathy 
• Non-ketotic hyperglycinemia 

Q. A floppy infant shows cortical thumb and scissoring of limbs. What should you think of?

Ans. Central Hypotonia

Also Read: Hearing Loss in Nicu Graduates

Hope you found this blog helpful for your NEET SS Pediatrics Neonatology Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.