From the Guidelines
A newborn with a fused posterior fontanelle should undergo comprehensive evaluation and monitoring, including cranial imaging and genetic testing, to determine the need for surgical intervention or other management strategies. The initial approach should include a complete physical examination to identify any associated abnormalities. Cranial imaging, preferably MRI or CT scan, is essential to assess cranial sutures and brain development 1. Additionally, genetic testing should be performed to identify potential syndromes.
Key Considerations
- Consultation with a multidisciplinary team, including a pediatric neurosurgeon, craniofacial specialist, and geneticist, is crucial for determining the best course of action.
- Isolated posterior fontanelle closure may not require treatment, but if it's part of craniosynostosis, surgical intervention may be necessary, typically between 3-9 months of age 1.
- The timing of surgical intervention depends on the severity of the condition and the presence of increased intracranial pressure.
- Parents should be educated about monitoring head growth, developmental milestones, and signs of increased intracranial pressure, such as excessive irritability, vomiting, or bulging fontanelles.
Ongoing Care
- Regular follow-up appointments are necessary to monitor head growth and development.
- Early intervention is crucial, as untreated craniosynostosis can lead to abnormal brain development, increased intracranial pressure, and neurodevelopmental issues.
- Transfontanellar ultrasound may be used to evaluate pediatric patients, including newborn or young infants with open anterior or posterior fontanels, but its usefulness is limited in cases with fused fontanelles 1.
From the Research
Management and Treatment for a Newborn with a Fused Posterior Fontanelle
- The management and treatment of a newborn with a fused posterior fontanelle may involve the use of imaging techniques such as ultrasound, CT, and MRI to evaluate the posterior fossa and detect any abnormalities 2, 3.
- Ultrasound is a valuable tool for evaluating the neonatal brain, particularly in non-traumatic emergencies, due to its lack of ionizing radiation and ability to perform exams at the bedside 2.
- The use of supplemental neurologic US imaging windows, such as the posterior fontanelle and mastoid fontanelle, can help detect pathologic conditions and structural malformations in the neonatal brain 4, 5.
- Posterior fontanelle imaging can improve the detection of intraventricular hemorrhage and depict clot extending into the occipital and temporal horns 5.
- Mastoid fontanelle imaging is particularly useful in detecting hemorrhage involving the brainstem, cerebellum, and subarachnoid cisterns, and can help distinguish holoprosencephaly from aqueductal stenosis and identify small malformations of the posterior fossa 5, 6.
- MRI remains essential to confirm findings and detect associated abnormalities, especially in cases of hypoxic-ischemic injury and small subdural and punctate cerebellar hemorrhage 2, 3.
Imaging Techniques
- Ultrasound through the posterior fontanelle can provide additional information and help visualize extensive damage in the occipital subcortical white matter and/or cortex in newborn infants with hypoxic-ischaemic encephalopathy 4.
- Cranial ultrasound through the mastoid fontanelle plays a pivotal role in the early detection of posterior fossa pathology and selection of neonates with an indication for MRI 6.
- The sensitivity and specificity of anterior fontanelle views for major posterior fossa abnormalities can be improved by adding mastoid fontanelle views, which can increase the sensitivity of ultrasound to 82% 3.