Microcephaly

Microcephaly is a rare neurological condition, in which the head of a newborn is smaller than that of other babies of the same age and gender, or it is also when the head of a newborn stops growing after birth.  Microcephaly can most times detected at birth. It can be congenital (from birth) or acquired (developed after birth). It may also be caused by genetics or environments, and can also occur in adults. DIAGNOSIS The diagnosis of microcephaly is simply by physical observation or examination and family traits. According to WHO, the most reliable way to assess whether a baby has microcephaly is to measure its head circumference (24 hours after birth), compare the value with WHO growth standards, and continue to measure the rate of the child’s head growth in early infancy.

• Physical Examination

To determine whether your child has microcephaly:

• Your doctor will take a thorough prenatal, birth, and family history.
• He or she will do a physical scan or exam.
• He or she will measure the circumference of your baby’s head and compare it with a growth chart.
• He or she will remeasure and plot the growth at future visits.
• He or she will also measure the parents’ head sizes to determine whether small heads run in the family.
• Scanning (CT or MRI)

The doctor will seek or request tests such as a head computed tomography scan or magnetic resonance imaging.

• Blood Test

Your doctor may request a blood test to determine the underlying cause of the child’s head development delay. A blood test will determine the type of infection (if any). TREATMENT There is no specific or generally accepted treatment for microcephaly, except for the surgery for craniosynostosis to separate the skull bones. Early intervention with stimulation and play programs may give a positive impact on development.  A multidisciplinary team is very important when it comes to assessing and rendering care and hospitality to babies and children with microcephaly. Family counseling and support for parents of patients suffering from microcephaly is also extremely recommended.  Early childhood intervention programs that may help strengthen abilities may include:

• Speech
• Physical therapy
• Occupational therapy.

Surgery For Craniosynostosis Your doctor may recommend traditional open surgery, the cranial vault remodeling. This is the surgical approach that doctors rely on and have relied on for decades, to treat craniosynostosis. It is typically performed on babies of 5–6 months and older.  The surgery is done with the help of a team of doctors.

1. Procedures For The Cranial Vault Remodeling.
2. The doctor makes an incision along the baby’s scalp.
3. The affected bone is removed.
4. Bone is reshaped and replaced to allow for improved overall head shape and increased space for developing the brain.
5. Procedures For Endoscopic Craniectomy.

This is a minimally invasive approach that is offered for babies up to three months of age. It is done with a team of doctors.  Here:

1. Incisions are made in a baby’s sleep.
2. With an endoscope (a thin tube with a light), the doctor sees the inside of the scalp.
3. The affected bone is removed.
4. Guide remaining skull growth with a molding helmet.

After an endoscopic surgery, the child is made to wear a cranial orthotic helmet for some time. The helmet will help in molding the child’s head into a normal shape while he or she is growing. Advantages Of Endoscopic Craniectomy The endoscopic procedures performed on babies of three months and younger show good results with fewer risks.  These positive outcomes include the below:

• Less blood loss during the procedure.
• Smaller incisions are involved.
• Hospital stay is shorter, compared to the cranial vault remodeling; usually one night only.

RISK FACTORS OF MICROCEPHALY All treatments come with their risks, whatsoever they are. In the same vein, microcephaly has certain numbered risks accompanying it.  These include:

1. Certain infections during pregnancy, eg: rubella, toxoplasmosis, zika virus, cytomegalovirus, etc.
2. Fever malnutrition.
3. Exposure to harmful substances like alcohol, certain drugs, or toxic chemicals.
4. Interruption of blood supply to the baby’s brain during development.

MORTALITY RATE The current estimate of CFR, considering all confirmed cases of microcephaly and all associated fetal (related to the fetus) or neonatal deaths, was 8.3%. The rate of current confirmed cases in 2021 is 30%. The confirmed rate of deaths is 64%.  On the whole, the mortality rate of craniosynostosis surgery was less than one percent (<1%). This confirms that craniosynostosis surgery is safe with low rates of mortality and acute complications.

Symptoms

SYMPTOMS

Microcephaly is a rare nervous system condition that causes a baby's head to be small and not fully formed. There can also be no growth in the head size of the baby as it advances in age. 

The primary signs and symptoms of a microcephaly child are:

• Head size significantly smaller than that of children of the same age and gender.
• A child's head not growing as it should, after birth.
• Some children have a head size too small, as it falls as low as the first percentile, while some with microcephaly fall significantly below average, possibly even below the first percentile for your baby's age and gender. 

A child with severe microcephaly may also have a backward-sloping forehead. When you observe abnormalities in the size of your baby's head, please seek your family doctor.

Other symptoms of microcephaly include all of the below:

1. Convulsions and seizures, encountered by the baby.
2. Learning disabilities as the baby's ability to understand will below. Performance in academic work may be remarkably hindered and also hinder social interaction.
3. Physical disabilities suffered by microcephaly patients. The growth rate might be abnormal.
4. Hearing loss.
5. Vision problems.
6. Cerebral palsy.

Causes

CAUSES

Microcephaly often results from abnormal brain development which can take place in the womb or during infancy. Microcephaly may be genealogical. Other factors may also play the role in the development of microcephaly. 

The causes responsible for microcephaly:

1. Neurological abnormal brain development.
2. Genetic mutation and abnormalities, e.g, Down syndrome.
3. Craniosynostosis: This is a birth defect in which the bones in the baby's skull join together before the baby's brain is fully formed. 

The skull is misshapen as the baby grows. Surgery is needed to separate the bones of the skull to allow the brain adequate space to grow and develop.

Fatal infection during pregnancy, e.g:

1. Zika virus.
2. Toxoplasmosis
3. Cytomegalovirus
4. German measles (rubella)
5. Chickenpox (varicella)

• Chromosomal abnormalities like Down syndrome.
• Cerebral anoxia (decreased oxygen to the brain of the fetus can cause serious complications in pregnancy or delivery).
• Malnutrition during pregnancy, which can affect a baby's brain development.
• Effects of drugs, alcohol, or certain toxic chemicals on pregnancy. When a fetus is exposed to drugs and dangerous chemicals, it may begin having brain abnormalities and the likes.
• Phenylketonuria: This is also a birth defect. It causes amino acids to build up in the body. If this condition is not controlled, the baby's brain development may be affected negatively.

FAQ

Do all babies with Craniosynostosis need surgery?

When needed, a surgical procedure is usually performed during the first year of life. However, the surgery's timing depends on which sutures are closed, and whether the baby has one of the genetic syndromes that can cause Craniosynostosis. Babies with very mild conditions might not need surgery.

How common is microcephaly?

Microcephaly is a rare disease that has an estimate (given by researchers) of about one in every eight hundred to five thousand (1:800–5000) babies born with microcephaly in the United States.

At what age is microcephaly diagnosed?

Early diagnosis of microcephaly can be made by fetal ultrasound. Ultrasounds have the best ability to diagnose microcephaly if they are made around 28 weeks of pregnancy. Often, diagnosis is done at birth or a later stage.

Is the zika virus still a threat?

As of January 2020, there are no areas with a current zika outbreak. If you are pregnant, then you may want to reconsider travel, because of the virus's link to birth defects and complications.

Does a small head always mean microcephaly?

Microcephaly is a birth defect that makes a newborn's head smaller than expected when compared to babies of the same age and gender. However, we should not misdiagnose microcephaly for other disorders that may have similar symptoms to it, such as Craniosynostosis.