All issues > Volume 49(11); 2006

Original Article

Korean J Pediatr. 2006;49(11):1158-1166. Published online November 15, 2006.

Diagnostic classification and clinical aspects of floppy infants in the neonatal and pediatric intensive care units

Eun Sun ES Kim¹, Kyung Eun KE Jung¹, Sang Duk SD Kim¹, Eo Kyung EK Kim¹, Jong Hee JH Chae¹, Han Suk HS Kim¹, June Dong JD Park¹, Ki Joong KJ Kim¹, Beyong Il BI Kim¹, Yong Seung YS Hwang¹, Jung-Hwan JH Choi¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence Jung-Hwan JH Choi ,Email: neona@plaza.sun.ac.kr

Abstract

Purpose
: The purpose of this study is to make a diagnostic classification and discuss a diagnostic strategy of floppy infants by investigating clinical, neurological, electrophysiological, and genetic analysis of infants admitted to intensive care units with the complaint of hypotonia.
Methods
: A retrospective study was performed from Jan. 1993 to Dec. 2005 in neonatal and pediatric intensive care units of Seoul National University Children's Hospital. Clinical features and all tests related to hypotonia were investigated.
Results
: There were 21 cases of floppy infants admitted to intensive care units. Final diagnosis was classified as centra (7 cases[33.3 percent]), peripheral (11 cases [52.4 percent]), and unspecified (3 cases [14.3 percent]). Among the central group, three patients were diagnosed as hypoxic ischemic encephalopathy, two patients as Prader-Willi syndrome, one patient as chromosomal disorder, and one patient as transient hypotonia. Among the peripheral group, four patients were diagnosed as myotubular myopathy, three patients as SMA type 1, two patients as congenital myotonic dystrophy, one patient as congenital muscular dystrophy, and one as unspecified motor-neuron disease. Motor power was above grade 3 on average, and deep tendon reflex was brisk in the central group. Among investigations, electromyography showed 66 percent sensitivity in the peripheral group, and muscle biopsy was all diagnostic in the peripheral group. Brain image was diagnostic in the central group, and Prader-Willi FISH or karyotyping was helpful in diagnosis in central group. Morbidity and mortality was more severe in the peripheral group
Conclusion
: Classification of diagnosis by clinical characteristics in this study, and application of investigations step by step, may provide an effective diagnostic strategy.

Keywords :Floppy infant , Intensive care unit