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Everything you need to know about the fontanel. The fontanel in newborns: when it closes, deviations from the norm, doctors' recommendations The structure of the fetal head, the main sutures of the fontanel

Parents of a newborn, as a rule, know that the baby has a fontanel on the head, or, as it is often called, a soft crown. Many of them are convinced that the fontanel in infants is a weak and vulnerable place that should not be touched once again. Is it true? Is there one fontanel in newborns? What is it for? Let's figure it out.

FEATURES OF THE STRUCTURE OF THE SKULL OF THE FETUS AND NEWBORN

The fontanelles of a newborn, and there are several of them, can be safely called “devices” given by nature to facilitate the process of the birth of a baby. During the passage of the fetus through the birth canal of the mother, its head can be deformed (in the good sense of the word) and take on the forms corresponding to the birth canal. This makes childbirth easier for both the baby and the mother.

Such anatomical "mutual understanding" is possible due to the structural features of the fetal skull. It consists of the same bones as the skull of an adult. But the bones of the baby's cranial vault are highly elastic and are interconnected by a kind of shock absorbers - non-ossified connective tissue areas.

These are sutures and fontanelles:

  • frontal or metopic suture - between the frontal bones;
  • coronal or coronal suture - between the parietal and frontal bones;
  • swept or sagittal suture - between the parietal bones;
  • occipital or lambdoid suture - between the occipital and parietal bones;
  • left and right scaly sutures - between the parietal and temporal bones;

  • anterior or large fontanel - a rhomboid membranous plate, from the corners of which the frontal and sagittal sutures, the left and right parts of the coronal suture depart;
  • posterior or small fontanel in children - a triangular depression at the intersection of the occipital and sagittal sutures;
  • left and right wedge-shaped fontanelles - at the junction of the coronal and scaly sutures;
  • left and right mastoid fontanelles - at the junction of the lambdoid and scaly sutures.

In a healthy full-term newborn, of all the listed membranous structures of the skull, only the large fontanel (anterior) and, in rare cases, the posterior small fontanel, are determined. And all the seams and other fontanelles are closed. In premature newborns, some sutures between the bones of the skull and lateral fontanelles may remain partially open.

The connective tissue membrane that forms the fontanelle in children resembles a tarpaulin in its density. Therefore, it is extremely difficult to violate its integrity. Bathe the baby calmly, if necessary, use a comb, play with the baby, give him a massage and do not be afraid to damage the fontanel.

The anterior children's fontanel is shaped like a rhombus. The doctor measures the size of the fontanel not along the diagonals of the rhombus, but along the lines connecting the midpoints of its opposite sides.

The sizes of a large fontanel in babies born at term vary from 2x2 cm to 3x3 cm. In premature babies, not only the fontanel is larger, but the areas of the skull sutures adjacent to it remain open.

Normally, the anterior children's fontanel is on the same level with the frontal and parietal bones surrounding it, or sinks quite a bit. Looking closely, you can see how the fontanel pulsates. With strong crying and anxiety of the baby, he may swell a little.

In the first year of a child's life, the brain grows quite rapidly in size. Due to the elasticity and compliance of the fontanel, the cranium does not interfere with the growth of the brain.

In addition, the fontanel in the baby performs the function of thermoregulation. When the child's body temperature rises through the large fontanelle, excess heat is released by the membranes of the brain, that is, they cool naturally. Therefore, never swaddle a feverish baby with his head and do not wrap his head in hats and scarves.

In a full-term baby, the size of the fontanel located behind, provided that it is not completely closed, is so small that the tip of the finger barely fits into the triangular recess.

In a healthy baby born at term, only the anterior large fontanel remains open. But as the bones of the skull grow, its size gradually decreases, and it closes.

For the age at which the anterior children's fontanel is completely closed, the norms are not strictly defined. In most newborns, this happens by 12, and sometimes by 18 months. But even if the fontanel is overgrown, and the child is not a year old, you should not worry. In a healthy baby, this may be a variant of the norm, which the pediatrician will certainly tell you about.

The posterior fontanel is usually not even determined by the time of birth. If you managed to find it, don't worry. It usually happens like this: by the time the anterior fontanel overgrows, there is no trace of the posterior one for a long time. It closes by 1.5–2 months.

FELLOW - SIGNAL LIGHT

As parents of a newborn baby, you should monitor the condition of the children's fontanel and tell the local pediatrician about all changes. If you notice that your baby's fontanel is pulsating strongly, or it seems to you that he has a very small fontanel (for example, you know the norm of its size), do not be silent, but share your observations with the doctor.

For neonatologists and pediatricians, the fontanel in the baby is a kind of signal beacon. He is the first to react to any trouble in the head of a newborn. By too early or very late overgrowth of the fontanel, the pediatrician may suspect a serious illness.

If at birth the anterior fontanelle is very small or completely absent, first of all, doctors exclude microcephaly and craniostenosis. In the first case, the child has all parts of the body of normal size, and the head (cranial skull and brain) is significantly behind in development. Microcephaly is often a manifestation of severe chromosomal diseases such as Patau syndrome, Edwards syndrome, etc.

With craniostenosis, the sutures between the bones of the skull are overgrown early, and the fontanelles are closed. Because of this, the head is deformed, the brain cannot grow normally, intracranial pressure increases with all the symptoms that follow from this.

The pressure inside the skull can be so high that the fused bones begin to separate again.

If a woman, being pregnant, ate a lot of foods containing calcium (cheese, milk, cottage cheese, etc.) and was fond of multivitamin preparations, her child's fontanel may close early. A lack of calcium in the body can cause late overgrowth of the fontanel.

If a full-term baby has a very large anterior fontanelle and an open posterior fontanel, he is examined for hydrocephalus (hydrocephalus) and congenital hypothyroidism (thyroid insufficiency). Doctors exclude or confirm intrauterine hypoxia, birth trauma and intrauterine infections, in which the size of the fontanel can also be above average.

The fontanel in children reacts to an increase (ICP) with tension and bulging.

ICP in infants increases with the following diseases and conditions:

  • congenital diseases (hydrocephalus, etc.);
  • brain infections (purulent meningitis, etc.);
  • volumetric formations in the cranial cavity (hematomas, tumors, etc.);
  • perinatal encephalopathy;
  • thrombosis of the sinuses and veins of the brain in severe infections, blood diseases, etc.

Important:if the bulging of the fontanel appeared immediately after the child received an injury (of the head and not only), immediately contact a medical facility or call an ambulance at home.

Be sure to pay attention not only to the bulging, but also to the sunken fontanel, which serves as an indicator of the degree of dehydration of the body. With intestinal infections due to vomiting and diarrhea, with neuroinfections due to repeated vomiting, dehydration develops very quickly. A child in such a situation requires urgent medical attention.

Note: with meningitis, the fontanel first swells due to an increase in ICP, and then, due to the loss of fluid by the baby's body, it sinks.

If a pediatrician or neurologist directs your baby to measure intracranial pressure, do not refuse this study. The procedure is absolutely safe and painless, but its results are quite informative. They will help the doctor make the correct diagnosis and promptly prescribe treatment for the baby, if necessary.

The fontanel in babies is a kind of "window" through which you can "look" inside the skull and brain of the baby.

Therefore, infants with access through the fontanel perform some diagnostic and therapeutic manipulations, such as:

  • subdural puncture under local anesthesia;
  • puncture of the ventricles of the brain to measure the pressure of the cerebrospinal fluid, study its composition and subsequent ventriculography;
  • puncture-free measurement of ICP using special tonometers;
  • two-dimensional echoencephalography and sonography - ultrasound studies;

  • radioisotope scintigraphy.

Zaluzhanskaya Elena, pediatrician

Reasons for measuring / examining the head:

1. The head first passes through the birth canal, making a series of successive movements.

2. Yavl. voluminous and most dense part.

3. The fontanels, which are clearly palpable during childbirth, make it possible to clarify the nature of the insertion of the head in the small pelvis.

4. The ability of the head to compress in one direction and in the other depends on the degree of density of the bones of the skull and their mobility.

the head of the fetus is bean-shaped. It consists of 2 parts: the face and the brain (volumetric) part. Skull - consists of 7 bones connected by sutures.

SEAMS: 1. Frontal - between 2 frontal bones. 2. Sagittate - between 2 parietal bones. 3. Lambdavid - between both parietal and occipital bones. 4. Coronal - between both parietal and frontal bones.

FELLOWS: fibrous plates at the junction of the sutures. The main ones are:

1. Large (front) - between the back parts of both frontal and front parts of both parietal. Represents a comp. mk. plate, in the form of a rhombus (3O3 cm). Intersection of 3 seams: 1,2,4.

2. Small (rear) - has a f-mu tr-ka. Between the posterior parts of both parietal and occipital bones.

Large and small fontanel conn. arrow seam.

3. Lateral (minor): anterolateral, posterolateral.

7 head sizes: 1) Straight - S from the bridge of the nose to the occiput. L=12 cm, d=34–35 cm.

2) Large oblique - S from the chin to the most distant point of the back of the head. L=13.5 cm, d=39–41 cm.

3) Small oblique - S from the suboccipital fossa to the middle of the large fontanel. L=9.5 cm, d=32 cm.

4) Middle oblique - S from the suboccipital fossa to the anterior corner of the large fontanel (scalp). L=10 cm, d=33 cm.

5) Large transverse - S between the most distant points of the parietal sutures. L=9.5 cm.

6) Small transverse - between the most distant points of the coronal suture. L = 8 cm.

7) Vertical (vertical) - S from the middle of the large fontanel to the hyoid bone. L=9 cm, d=32–34 cm.

Pelvis from an obstetric point of view

Taz: The female pelvis is wider and shorter, the wings of the ilium are turned to the sides, the entrance to the small pelvis has the shape of a transverse oval, the shape of the cavity of the small pelvis is cylindrical, the angle between the lower branches of the pubic bones is obtuse or straight.

In obstetric practice, the small pelvis is divided into 4 sections by conditional planes, which fan-shaped diverge from the pubic symphysis to the sacrum. In clinical practice, the following sizes of the female pelvis are more often used: distantia spinarum - the distance between the anterior superior iliac spines is 25–26 cm; distantia cristarum - the distance between the iliac crests is 28–29 cm; distantia trochanterica - the distance between large skewers is 30–31 cm; true, or obstetric, conjugate - the distance between the posterior edge of the pubic symphysis and the cape is 11 cm. To determine the obstetric conjugate, it is necessary to subtract 9 cm from the outer straight size equal to 20–21 cm - a distance equal to the thickness of the tissues and the spinal column.

Normal size of the pelvis. Determining the truth of a conjugate

Full external pelvis measurement:

1. Distantia spinarum is the distance between the two anterior superior iliac spines (in N = 25 - 26 cm)

2. Distantia cristarum is the distance between the most distant points of the ridges (in N = 28 - 29 cm)

3. Distantia trochanterica is the distance between two skewers (in N = 30 - 31 cm)

4. Conjugata externa is the distance between the anterior upper part of the pubic articulation and the supra-sacral fossa (in N = 20 - 21 cm)

If all 4 sizes are in N, you can deliver through the natural birth canal.

5. Conjugata diagonalis - S from the lower edge of the promontory to the symphysis (in N = 13 cm).

6. Conjugata vera - to determine it - 9 cm is subtracted from Conjugata externa (N = 20–9 = 11 cm).

7. Soloviev index - wrist circumference (in N = 13 - 18 cm). If the Solovyov index is less than 16 cm, then the bones of the skeleton are considered thin and Conjugata vera = Conjugata diagonalis - 1.5 cm. If the Solovyov index is 16 cm or more, then the capacity of the pelvis will be less (Conjugata vera = Conjugata diagonalis - 2 cm).

8. Lateral Kerner conjugate is the distance between the anterior superior and posterior superior spines of the same side (in N = 15 cm)

9. The height of the womb - in N = 5 cm

10. The height of the pelvis - the distance between the ischial tubercle and the pubic tubercle (in N = 9 cm)

11. Rhombus of Michaelis is a rhombus, the tops of which are points: on top - the supra-sacral fossa, below - the upper edge of the gluteal fold, from the sides - the posterior superior iliac spines. Vertical dimension - 11 cm. Transverse dimension (Tridandani distance) - 10 cm.

12. Pelvic circumference - the circumference of the hips in a non-pregnant state (in N at least 85 cm).

Objective methods for assessing fetal viability

periods of fetal viability. From 28 to 37 weeks - the antenatal period - the period of the life of the fetus during pregnancy.

The intranatal period is the period of life of the fetus in childbirth.

The postnatal period is divided into:

Early - neonatal (first 7 days)

Late - up to a month of life.

Childbirth. Premature - occur from 28 to 37 weeks inclusive.

Term delivery - 37 - 42 weeks.

Late delivery - 43 or more weeks.

New criteria for live birth.

· Gestational age 22 - 27 weeks.

Fruit weight 500 - 1000 g.

Fruit length - 25 cm or more.

· There is one of the signs: "heartbeat", "spontaneous breathing", "reflexes", "pulsation of the umbilical cord".

If lived 7 days of life.

Assessment Methods: 1) Non-invasive: determination of the level of α-fetoprotein. The study is carried out at 15–18 weeks. The level of fetoprotein in malformations, pathological. course of pregnancy.

Ultrasound - 3 times - first visit ♀ - pregnancy diagnostics. 2 - at 16-

18 weeks assessment of growth rates, detection of anomalies in development. 3 - 32-35 weeks. - condition, growth rate, term, articulation, weight of the fetus.

CTG, hysterography - continuous. at the same time register of fetal heart rate and uterine tone.

2) Invasive: amniocentesis - puncture of the amniotic fluid. The goal is cultivation, karyotyping. Chorionic biopsy - performed for karyotyping. Cordocentesis is the puncture of the vessels of the umbilical cord of the fetus in order to obtain its blood.

Hormonal function of the placenta

Placenta (P.) - "baby place", endocrine gland, cat. combines func. ♀and fetus systems. By the end of pregnancy, M = 500 gr., d = 15–18 cm. In the placenta, a child's place, the maternal side, and the fruit side are distinguished. Pl. - lobular organ (50–70 lobules). Functions: gas exchange, endocrine function, protective, excretory. maternal and fetus. the bloodstream do not communicate with each other.

Hormonal function: Pl. together with the fetus image. a single endocrine system (fetoplacental system). In Pl. impl. etc. synthesis, secretion, transformation of hormones of protein and steroid nature. Hormone production occurs in the trophoblast syncytium, the decidual tissue. Hormones Pl.:

- placental lactogen (PL) - is synthesized only in the placenta, enters the mother's blood, maintains placental function.

- chorionic gonadotropin (CG) - is synthesized by the placenta, enters the mother's blood, participates in the mechanisms of fetal sex differentiation.

- prolactin - synthesis. placenta and decidular tissue. – plays a role in the image and surfactant.

From cholesterol, containing. in the mother's blood, in the placenta image. pregnenolone and progesterone. Steroid hormones also include estrogens (estradiol, estrone, estriol). They cause hyperplasia and hypertrophy of the endometrium and myometrium.

In addition to these, Pl. capable of producing testosterone, CS, thyroxine, parathyroid hormone, calcitonin, serotonin, etc.

Intrapartum fetal protection

The effect of childbirth on the condition of the fetus: the fetus is experiencing an increasing dose of hypoxia, hypercapnia, acidosis. Escort fight. decrease in uterine hemodynamics. A complicated birth act exacerbates intrauterine hypoxia. During childbirth, the condition of the fetus worsens in parallel with the pharmacological load, and some of the pr-you turned out. not direct toxic. d-e, but indirect.

The value of the position of the body of the woman in labor: the position of the pregnant woman. presented on the back. add. load on the CCC, and breathe. woman's system. For the outcome of childbirth and the condition of the fetus, and then for n / r. The position of the mother is of no small importance. The most physiological in time an attempt - a half-sitting or sitting position, as well as a position on the side. Childbirth in horizontal. position and more often accompanied. traumatization of the fetus and greater physiological. blood loss.

Operative delivery: All operations are charact. traumatic for the fetus. At the same time, they help ↓ perinatal mortality. Imposition of A. forceps - can lead to birth trauma n / r. Caesarean section - allows noun. ↓ perinatal mortality. Of decisive importance is the timeliness of the operation, when it is possible to avoid prolonged labor, a long anhydrous period and the onset of fetal hypoxia. Wrongly chosen anesthesia, technical errors can have a negative effect on the fetus.

Features of care: after extraction from the uterus, the child undergoes the usual range of resuscitation measures, aerosol therapy is prescribed, and often breath stimulants. and heart. activities. The frequency of complications reaches 10.9% (operation during childbirth) and 1.7% (planned). The prognosis depends on the nature of A. pathology. The prognosis improves if the operation was performed in a planned manner.

Birth trauma: There are birth trauma, birth injuries and obstetric trauma. The first arose. under d-em physical. loads, properties. complication childbirth. The latter more often arose more easily where there is an unfavorable background in the womb. development, aggravated by hypoxia in childbirth. For acute or chronic zab-yah ♀, poisoning, pathological. during pregnancy, polyhydramnios, multiple pregnancies, overmaturity / prematurity, rapid / protracted childbirth, conditions are created for the occurrence of birth trauma.

Causes of intrauterine hypoxia and fetal death in childbirth: There are acute and chronic. fetal hypoxia: Chronic - 1. Maternal obstruction (decompensated heart defects, diabetes, anemia, bronchopulmonary pathology, intoxication, info). 2. Complications of pregnancy: late preeclampsia, overdose, polyhydramnios. 3. Zab-I fetus: hemolytic. disease, generalizations. IUI, malformations.

Acute - 1. Inadequate blood perfusion to the fetus from the maternal part of the placenta. 2. Detachment of the placenta. 3. Clamping of the umbilical cord. 4. Inability to tolerate changes in oxygenation, connection. with uterine contractions.

Causes of fetal death in childbirth: 1. Fetal asphyxia. 2. Hemolytic disease. 2. Birth trauma. 3. VUI. 4. Malformations of the fetus.

18. Perinatology, definitions, tasks

Perinatology (antenatal p. - p. from 28 weeks before the onset of regular labor; intranatal - childbirth; postnatal - 7 days after birth). Tasks: 1. Prevention of pathology in childbirth.

2. Prevention of malformations.

3. Diagnosis of malformations.

4. Diagnosis and treatment of fetal distress.

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Publication date: February 7, 2012

    

cranial sutures- fibrous bands of tissue that connect the bones of the skull. The skull of a child consists of six separate bones of the skull (frontal bone, occipital bone, two parietal bones and two temporal bones). These bones are held together by strong, fibrous, elastic tissues called cranial sutures. The spaces between the bones where the sutures are located (sometimes referred to as “soft spots”) are called fontanelles. They are part of normal development. The skull bones remain separate for about 12-18 months. Then they grow together. They remain fused throughout adult life. The posterior fontanel (at the back of the head) usually closes by the time the baby is 1 or 2 months old, or may already be closed shortly after birth. The anterior fontanel (at the top of the head) usually closes somewhere between 9 and 18 months. seams and fontanelles, are necessary for the baby's brain, for its growth and development. During childbirth, the flexibility of the fibers allows the bones to overlap so that the head can pass through the birth canal without pressing or damaging the baby's brain. During infancy and childhood, the fibers are flexible. This allows the brain to grow quickly, as well as being shielded from minor impacts on the head (such as when a child is learning to hold its head, roll over, and sit up). Without flexible sutures and fontanelles, the baby's brain will be squeezed into the cranial bone and won't be able to grow enough. The child will develop brain damage. Feeling the cranial sutures and fontanelles is one way doctors and nurses monitor the growth and development of a child. They are able to assess the pressure in the brain, feeling the tension of the fontanelles. The fontanelles should feel flat and firm. Bulging fontanelles can be a sign of increased pressure in the brain. In this case, doctors may need to use imaging techniques such as CT scans or MRIs. Surgery may be needed to relieve high blood pressure.

In this article:

The fontanel in newborns is a patch of connective tissue located at the junction of three or more bones of the skull. These non-ossified fragments facilitate the process of childbirth, as they make it possible to deform the skull, slightly shifting the edges of the cranial bones against each other when the fetal head passes through the birth canal.

After the birth of the baby, the connective membranous tissue gradually hardens, the size of the pulsating interosseous space decreases, and the fontanel closes.

Location of fontanelles

Parents should be able to find the fontanelles of the skull of a newborn in order to monitor their condition. To do this, you need to know how many fontanelles a newborn has and what is their localization.

There are six connecting membranes:

  • unpaired (two) - located along the midline of the cranial vault, called the anterior and posterior;
  • paired (four) - two on each side, called wedge-shaped and mastoid.

Usually, parents can find and measure only unpaired fontanelles on their own, paired ones are more difficult to detect, they are smaller or almost closed by the time of birth.

Where is the fontanel located in a newborn, which is the main one and whose condition is controlled by a pediatrician? It is located in the midline between the frontal and parietal bones and is called the large anterior.

The small fontanel in children is called the back in a different way. This is a fontanel located in the middle line between the parietal and occipital bones.

It is useful for parents to be familiar with paired wedge-shaped and mastoid springs. They are located on the lateral surfaces of the skull, two on each side. The sphenoid membranes are located at the junction of the temporal, frontal and parietal bones, where they are connected to the intracranial sphenoid bone. They can be felt in the temples of the baby. Mastoid "windows" are located at the junction of the eponymous process of the temporal bone with the parietal and occipital bones (or behind the ears of the little one).

There are also inconsistent fontanelles, which are not found in all babies. These include nasolabial, parietal and cerebellar. The fontanel may be in the seam between the frontal bones.

Dimensions and shape

What should be the anterior fontanel in a newborn? The shape of the fontanel in a newborn is diamond-shaped. At birth, the dimensions are from 2.5 to 3 cm. Sometimes, in the absence of pathology, the interosseous membrane can be small in size - 0.5 cm. The value is calculated by dividing the sum of the longitudinal and transverse diameters of the rhombus by two.

During the first month of life, the size of the fontanel in newborns may increase slightly, which is associated with a change in the shape of the skull after childbirth and active brain growth. The process of inevitable size reduction begins at the age of four months. The pulsation noticeably decreases from 8 months, the fontanel becomes rounded.

Normally, the posterior fontanelle has a triangular shape. In size, it is much smaller than the front one and, as a rule, does not exceed 7 mm. The wedge-shaped and mastoid fontanelles are small in size, the norm is 0.6-1 cm, it also resembles a triangle in shape.

When overgrown

When does the fontanel grow in newborns? Connective tissue is transformed into bone tissue starting from the periphery, over a certain period of time. The diameter of the "window" gradually decreases. There are no exact and identical terms for ossification for all children, let's say a certain time range when the fontanel overgrows. In this case, most often refers to the anterior fontanel.

The fontanel finally closes by the end of the first year. These norms can change even with the normal development of the baby. The softness of the connective tissue membranes in this area can be maintained in a healthy child even at 2 years old.

The posterior fontanelle usually closes within the first two months of life.

When does the wedge-shaped fontanel heal? Basically, these fontanelles close at 2-3 months of age. But if the child was already born with closed wedge-shaped fontanelles, the ossification of these membranes occurs in the first six months of the baby's life.

What time does the fontanel in infants, called the mastoid, overgrows? The timing of its ossification approximately coincides with the closure of the wedge-shaped fontanel. That is, at 2-3 months of life.

Thus, when the fontanel in an infant should overgrow, it is unambiguously difficult to answer. In many ways, the healing period depends on genetic characteristics, mother's nutrition during pregnancy and the nature of feeding. The gender of the baby also affects - according to medical statistics, in boys, the connective membrane closes much faster.

But even with early closure, the growth of the brain is ensured by the presence of sutures between the bones of the skull, which do not overgrow until the age of 15-19.

Deviations in development

Usually parents are concerned about changes in the size of the connective membrane. Pathological abnormalities may be suspected upon inspection and measurement of the fontanelles. To identify the pathology, the obtained dimensions are correlated with the normal value corresponding to the age of the crumbs.

The fontanel in a newborn increases under the following pathological circumstances:

  • decreased thyroid function;
  • (accumulation in the brain of an excess amount of cerebrospinal fluid), while the fontanel in the baby is enlarged, tense, closes later;
  • genetic pathology (Down syndrome, chondrodysplasia, Apert syndrome, clavicular-cranial dysplasia, glass man syndrome).

Most often on the head of a baby is observed during premature birth. Fontanelles close more slowly.

There are also provoking factors that contribute to the formation of a large fontanel:

  • hereditary predisposition;
  • violations in the diet and daily routine of the expectant mother (lack of dairy products and unbalanced nutrition, overwork);
  • bad ecology;
  • maternal and infant stress.

It is believed that the fontanel may be smaller than normal if a pregnant woman eats too many foods containing calcium. In this case, the "windows" close faster.

Microcephaly is characterized by premature closure of all membranous connections during the first months of life. In this case, the infant's anterior fontanel may be small, and the remaining five may be closed already at birth.

Which doctor to contact if you suspect a deviation

Up to six months, parents should especially carefully control the size of the interosseous membranes. If by eight months the connective membrane has changed little in size since birth, a pediatrician should be consulted.

If the dimensions are normal, but the fontanel bulges or, conversely, is below the level of the bones of the skull, an urgent need to contact the observing children's doctor. He will prescribe all the necessary tests, examinations. If necessary, the child will be consulted by a pediatric neurologist.

Examinations for suspected abnormalities

The following points should be monitored by the pediatrician during the examination:

  • The consistency of the connective tissue plate and the edges of the cranial bones, their structure and density.
  • The size of the fontanel and the dynamics of changes.
  • Contours of interosseous membranes.
  • Skull circumference.

The data obtained should be correlated with the age of the baby and the characteristics of its development.

If the fontanel does not overgrow at 2 years, the following examinations are necessary:

  • examination by a pediatrician to exclude rickets (with this disease, compliance of the edges of the skull bones, flattening of the occiput, sweating, curvature of the lower extremities are detected);
  • genetic counseling;
  • a blood test for the content of thyroid hormones to detect its hypofunction.

If a closed fontanel is detected in a newborn or the membranes begin to close during the first months of life, pediatricians talk about the early closure of the fontanel. This may be due to congenital craniostenosis, anomalies in the development of the skull or brain, genetic diseases, intrauterine infections.

If the "windows" are practically closed, but the size of the skull and psycho-physical development correspond to the age norm, parents have nothing to worry about.

Of the instrumental methods, ultrasound, magnetic resonance imaging of the brain are used.

Bulging fontanel

The pulsation of the fontanel in infants often worries parents. But in a newborn, the fontanel pulsates during crying, tension, anxiety. You also need to remember that the fontanel pulsates when pressed, this is the norm and should not cause alarm.

A convex fontanel in a baby is always a warning symptom. In the presence of a convex pulsating fontanel, experts speak of an increase in intracranial pressure.

Intracranial hypertension may be due to the following pathological circumstances:

  • infectious process (encephalitis, meningitis);
  • neoplasm of the brain;
  • birth trauma of the skull, complicated by cerebral edema or intracerebral bleeding;
  • hydrocephalus.

Why does the fontanel pulsate in a child? Rhythmic oscillations of the membrane correspond to cardiac contractions, causing movements of the cerebrospinal fluid.

But if the fontanel pulsates in an infant, and this is accompanied by a violation of the general condition, the appearance of a convulsive syndrome, loss of consciousness, it is urgent to call an ambulance.

sunken fontanel

Due to dehydration due to intestinal infection, neurotoxicosis, or violations of the drinking regime, there may be a retraction of a dense plate that closes the space between the bones of the infant's skull. In this condition, plentiful drinking, balanced infusion therapy and other symptomatic therapeutic measures are necessary.

In the absence of dehydration and violations of the general condition, retraction of the interosseous membrane may be in a post-term baby.

How to care for a fontanel

The membranes between the bones do not need special care, their dense tissue reliably protects the baby's brain, it is difficult to damage it.

But there are simple rules to follow:

  • you can not press hard on the connecting membrane, you need to touch it gently and carefully;
  • it is necessary to contact a pediatrician if the fontanel sinks or sticks out;
  • avoid skin damage in the area of ​​open sutures and fontanelles;
  • children need to be turned over regularly so that they do not sleep on one side, as this can aggravate the deformation of the skull;
  • apply baby cream to newborns on flaky skin in the area of ​​\u200b\u200bthe membrane between the bones, then carefully comb out the exfoliated crusts.

It is necessary to pay maximum attention to the child: pick it up more often, put on a hat, try to avoid his excessive crying and anxiety. It is important for a young nursing mother to have a nutritious diet enriched with calcium and vitamins. If necessary, the pediatrician prescribes vitamin D to the baby in an age dosage.

Fontanelles protect the developing brain from excessive pressure, providing an opportunity for growth, protect against overheating, and play the role of a shock absorber in case of injury. The dynamics of the overgrowth of the membranes between the bones up to a year is an important indicator of the health of the baby. If there are deviations in the rate of their closure, an urgent consultation of the attending pediatrician is necessary, as this may be a signal of serious problems with the child's health.

Useful video about the fontanel in a newborn

The local pediatrician should be able to examine the head of a newborn and as an orthopedist. An orthopedic examination of a newborn begins with an examination and examination of the head, the ability to hold it, then an examination of the face (its symmetry is noted) and neck. Particular attention is drawn to the condition of the sternocleidomastoid muscle (are there any seals, shortening of one of their legs).

When examining the head of a newborn, you need to pay attention to:

Position in relation to the body;

Dimensions;

Proportions of the brain and facial skull;

Sizes of fontanelles;

Condition of the cranial sutures;

Bone density.

Inspection of the head should be combined with its palpation, and where necessary, percussion should also be carried out. If there are features, they should be noted.

The position of the head of a healthy newborn is due to the presentation in childbirth and the presence of physiological hypertonicity of the flexors (the head is slightly brought to the chest).

Traumatic injuries in childbirth of the sternocleidomastoid muscle or the lower cervical and upper thoracic segments of the spinal cord lead to the deviation of the head to the right or left. In all cases, consultation with an orthopedist and a neurologist is required.

In a newborn child, the brain skull prevails over the facial one. The frontal and parietal tubercles stand out distinctly. Quite often, in the back of the head, on the border of the scalp, there are red spots with blurry borders that do not rise above the surface of the skin. Their borders are irregular. Under the pressure of the finger, the redness disappears, but then reappears. Increases with crying. These spots ( telangiectasia) are due to local expansion of rudimentary remains of embryonic vessels. They disappear on their own within 1-1.5 years and are only a cosmetic defect that does not require treatment. They should not be mixed with true vascular nevi, which have a darker, more saturated color and do not disappear when pressed. They do not go away after 1.5 years of life, but on the contrary, sometimes increase in size.

The scalp may have silvery-shiny or dull gray scales ( gneiss) - manifestation of seborrheic dermatitis.

The shape and size of the head is very individual and can be a manifestation of both constitutional features and the result of birth deformities (indentation, protrusion). Various hereditary and infectious diseases in the neonatal period (rubella, measles, mumps, influenza, cytomegalovirus infection, toxoplasmosis, etc.), as well as endocrine pathology, can lead to changes in the shape of the head or to a change in its size.

Variants of the normal shape of the head in a newborn are:

Bracheocephalic (head with a relatively weak development of the longitudinal diameter and a relatively large diameter);

Dolichocephalic (the skull is elongated in the anterior-posterior direction);

Tower (the skull is extended vertically). Occurs rarely.

Wedge-shaped deformation to the right or left is also possible.

At premature newborn skull shape resembles that of hydrocephalus. This is due to the relatively earlier maturation of the brain substance. A similar large head also occurs in a healthy full-term child who has large heads in the family (dominantly or recessively inherited trait) in the absence of other dysembryogenesis stigmas and normal indicators of neurological status. These cases are not considered pathological.

To changes in the shape of the head of a newborn can also lead to injuries during childbirth, which are clinically manifested in the form of:

birth tumor;

cephalohematomas;

Changes caused by a vacuum extractor or forceps.

birth tumor- congestive edema that occurs on the presenting part of the fetal body during childbirth (nape, crown, face, etc.). It is localized, as a rule, over two or even three bones and is characterized by the absence of clear boundaries and a pasty consistency. Its color may be cyanotic, turning into normal tissue. In the area of ​​the birth tumor, there are almost always hemorrhages in the skin and subcutaneous tissue. This is especially noticeable in the localization of edema in the forehead and face. It resolves on its own by the 1-2nd week of life.

cephalohematoma- subperiosteal hemorrhage resulting from rupture of a blood vessel during childbirth, as a result of birth trauma (forceps, vacuum extractor, bone formations of the mother's small pelvis). It is often localized in the parietal or occipital region and is limited to only one bone without going beyond the suture. It has a slightly dense and fluctuating texture. From the 7-10th day, the cephalohematoma begins to gradually decrease. It resolves very slowly and usually disappears completely after the first month of life.

Changes Caused by the Vacuum Extractor, resemble a birth tumor in combination with a hematoma under the aponeurosis.

Changes caused by the application of forceps, appear as an impression in the temporal or parietal regions (the ping-pong ball phenomenon).

Pathological forms of the head include:

Acrocephaly ("tower skull", a high skull of a conical shape, somewhat flattened in the anterior-posterior direction). Occurs as a result of premature fusion of sutures. Occurs with syndromes: Cruzon, Aper, Vanderburgh;

Scaphocephaly (navicular elongated skull, elongated skull with a protruding ridge in place of a prematurely overgrown sagittal suture) - Aper's syndrome;

Plagiocephaly (oblique head, oblique skull). Asymmetry of the skull due to premature ossification of part of the coronal suture.

Head size expresses it circle. It is measured with a centimeter tape, which should pass through the most protruding supraorbital and occipital points. Head circumference should be measured at first and subsequent visits and compared with baseline (normal head circumference at birth ranges from 34 to 36 cm). A head circumference at birth below 34 cm in a premature baby or with a head configuration during childbirth (usually recovering after 2-3 weeks) is not considered a pathology.

The pathological dimensions of the head include:

Macrocephaly - head circumference greater than 36 cm (megacephaly, large head). A similar head occurs with hydrocephalus as a manifestation of an independent disease. In addition, hydrocephalus can be one of the manifestations of some syndromes: Holter-Muller-Wiedemann, Beckwith, Alexander, Canavan, Payle, Paget, etc.;

Microcephaly - head circumference less than 34 cm (small head). With microcephaly, there is redundancy of the skin on the head and an increased density of its bones. Occurs in: alcoholic embryopathy, toxoplasmosis, Greg and Bloch-Sulzberger, Patau, Wolf-Hirschhorn, Edwards, etc. syndromes.

By the end of the first month of life, head circumference increases by an average of 1.5-2 cm. Head growth retardation can be a constitutional sign, as indirectly evidenced by the small size of the head in one or both parents, or a symptom of delayed brain development. Accelerated growth of head circumference during the neonatal period, if this is not a constitutional feature, indicates hydrocephalus.

The skull of a newborn is represented by a large number of bones (Fig. 2), the density of which, the size of the fontanelles and cranial sutures are determined and evaluated by palpation.

Figure 2. Bones of the skull and fontanelles in a newborn

1 - scales of the occipital bone; 2 - small fontanel;

3 - parietal bone; 4 - large fontanel; 5 - frontal bone.

The bones of the skull of a healthy newborn are quite dense, except for the places where they join - future sutures. A decrease in the density of the bones of the head indicates either prematurity or a violation of intrauterine ossification. The latter can be in the form of lacunar osteoporosis (soft skull) or osteogenesis imperfecta, when there is no ossification of all the bones of the skull (membranous skull). The ossification of the parietal and occipital bones is more often delayed. In contrast to the usual delay in ossification and lacunar osteoporosis, when the affected bones feel evenly soft to the touch and, as it were, slightly springy when pressed, with the so-called lacunar skull, the bones are palpated like honeycombs, since with this form of damage, softening areas are separated by thin bone septa. The prognosis for isolated lacunar osteoporosis is favorable. At the age of 2-3 months, the foci of osteoporosis disappear. However, the lacunar skull is often combined with other malformations of the skeleton and internal organs, with hydrocephalus.

When talking about the seams of the bones of the roof of the skull of a newborn, they mean connective tissue layers at the junctions of the bones, at the places of future seams - metopic, frontal, coronal, sagittal and lambdoid. The metopic suture between the frontal bones is already partially formed by birth, so that only that part of it that is adjacent to the large fontanel is determined by palpation ( anterior, frontal), located at the junction of the metopic suture with sagittal and coronal. The rest of the sutures are palpable throughout. At the junction of the sagittal and lambdoid sutures, there is a small fontanelle ( posterior, occipital). In places where the frontal bones converge with the parietal and temporal bones, there are two anterior lateral fontanelles ( anterior-lateral), and between the parietal, temporal and occipital - two posterior lateral ( mastoid). The bones of the skull adjacent to the sutures are less dense.

Lateral fontanelles (anterolateral and mastoid) have an irregular shape. They may be closed at birth or close during the neonatal period. The small posterior fontanel (occipital) may be open. Its shape is triangular. The large fontanel is diamond-shaped. Its dimensions more accurately characterize the oblique diameters, which are measured between the edges of the frontal and parietal bones, most protruding into the fontanel and marking the border of the latter (Fig. 2). Separately, the size of the fontanelle between the right frontal and left parietal bones and the left frontal and right parietal should be measured. This parameter in a newborn should not exceed 2.5x3.0 cm, i.e. the width of one or two fingers.

Enlargement of fontanelles and the distance between the bones of the skull roof may be a consequence of:

prematurity;

Ossification disorders;

congenital hydrocephalus.

Any increase in the size of the head by 1-2 cm and a large fontanel over 3.0 cm compared to the norm with an open sagittal suture over 0.5 cm in combination with a typical bracheocephalic head shape with enlarged frontal tubercles or a dolichocephalic shape with an overhanging occiput is characteristic sign of hypertensive-hydrocephalic syndrome.

Complete closure of the lateral and small fontanelles by birth, combined with the small size of the large, and sometimes flattening of the edges of the bones up to the complete closure of the sutures, is a sign of congenital microcephaly or craniostenosis. More often there is a fusion of one seam.

In the first month of life, the rate of change in the size of sutures and fontanelles is of practical importance. Rapid, steadily progressive enlargement of the fontanelles and rupture of the sutures is a sign of increased intracranial pressure. Accelerated closure of fontanelles and sutures is observed with damage to the central nervous system.

On palpation of the large fontanel, not only its size is determined, but also the degree of tension of the connective tissue membrane covering it. In this case, the child should be in a relaxed state, not screaming or straining. Its position must be vertical. Usually, both visually and by palpation, the fontanelle is flat and slightly sunken compared to the surrounding surface of the skull. Fingers (index and ring) determine the degree of resistance in response to light pressure and the degree of bulging of the connective tissue membrane. Bulging of the large fontanel or its increased resistance to pressure indicates an increase in intracranial pressure.

Retraction of the large fontanel and excessive compliance of the membrane usually indicates dehydration of the body (exicosis).

With the help of palpation of the fontanel, you can also obtain information about the nature of the blood circulation. With circulatory failure, accompanied by an increase in venous pressure, the fontanel is tense, its pulsation is increased.

Percussion can reveal hydrocephalus or subdural hematoma.

In a healthy child, the percussion sound is evenly dull over the entire surface of the head. A change in percussion sound like the sound of a "cracked pot" is one of the symptoms of hydrocephalus. In this case, the sound may be changed on one side or locally, which may indicate a subdural hematoma.

The combined asymmetry of the bones of the skull and face is a reflection of intrauterine disorders, most often of the embryonic period.