A newborn with a skin lesion on the back

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A newborn with a skin lesion on the back

J Fam Pract. 2007 January;56(1):E1-E3

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References

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Evaluation: The neonate with a midline cutaneous lesion

The incidence of OSD appears low in newborns with midline cutaneous lesions, but irreversible orthopedic, urologic, and neurologic problems from OSD may occur later in life. These complications can be prevented by early surgical intervention; therefore, it is critical that you do not miss a diagnosis of OSD and pursue spine imaging.

The definitive test, an MRI,^3,6,9 usually requires sedation of infants,¹¹ making high-resolution ultrasound the recommended choice for initial screening.^3-10 Ultrasound is not invasive and may allow for testing in the hospital nursery. After age 3 months, when ossification of the posterior spine limits visualization of the spinal cord by ultrasound, consider an MRI first. If the ultrasound demonstrates OSD or is inconclusive, follow with an MRI for a more specific diagnosis.

FAST TRACK

High-resolution ultrasound is recommended for the initial screening of OSD

Indications for an ultrasound of the newborn’s spine include any one of the following: an abnormal antenatal ultrasound; a midline cutaneous lesion other than a simple dimple; presence of other OSD related anomalies; or an abnormal neurologic exam.⁵ The authors of this protocol retrospectively applied it to 223 infants who had an ultrasound, and it reduced the number of tests by 50% without missing a single case of OSD.

If you are caring for a newborn infant you should resist the temptation to simply remove a midline cutaneous lesion, including a pseudotail, in the nursery without first searching for OSD. If OSD is present, neurosurgical consultation should be obtained as soon as possible. The optimal time for surgical intervention is within the first 4 months of life.⁴

Patient outcome

The infant’s pseudotail was removed without consequence and postoperatively the patient has thrived.

CORRESPONDENCE
Timothy J. Benton, MD Assistant Professor, Associate Residency Program Director, Texas Tech University Health Sciences Center at Amarillo, School of Medicine, Department of Family and Community Medicine, 1400 Wallace Boulevard, Amarillo, Texas 79106. E-mail: timothy.benton@ttuhsc.edu

A newborn with a skin lesion on the back

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