Microcephaly

What is microcephaly?

Microcephaly is a condition that is present at birth in which the baby's head is much smaller than normal for an infant of that age and gender. "Micro" means small and "cephaly" refers to the head. Most children with microcephaly also have a small brain and mental retardation. However, some children with small heads have normal intelligence.

What causes microcephaly in newborns?

Microcephaly is either caused by exposure to harmful substances during the fetal development, or it may be associated with genetic problems or syndromes that may have a tendency to run in families.

Theories suggest that the following may predispose a fetus to problems that affect the normal development of the head during pregnancy:

• Exposure to hazardous chemicals/substances.
• Exposure to radiation.
• Lack of proper vitamins and nutrients in the diet.
• Infection.
• Prescription or illegal drug and alcohol consumption.
• Maternal diabetes.

Microcephaly in babies can occur alone or in association with other health problems, and may occur from inheritance of an autosomal recessive, or rarely, an autosomal dominant gene. Acquired microcephaly may occur after birth due to various brain injuries such as lack of oxygen or infection.

Autosomal recessive and autosomal dominant are two patterns in which genes are inherited in a family. Genes determine our traits, such as eye color and blood type, and can also cause disease. Autosomal means that both males and females are equally affected. Recessive means that two copies of the gene, one inherited from each parent, are necessary to have the condition (in this case, microcephaly). After parents have had one child with autosomal recessive microcephaly, there is a 25 percent chance, or one in four chance, with each pregnancy, to have another child with microcephaly.

What are the symptoms of microcephaly?

The following are the most common signs and symptoms of microcephaly. However, each child may experience symptoms differently. Symptoms may include:

• Appearance of the baby's head is very small.
• High-pitched cry.
• Poor feeding.
• Seizures.
• Increased movement of the arms and legs (spasticity).
• Developmental delays.
• Mental retardation.

The symptoms of microcephaly may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is microcephaly diagnosed?

Microcephaly may be diagnosed before birth by prenatal ultrasound, a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

In many cases, microcephaly may not be evident by ultrasound until the third trimester, and, therefore, may not be seen on ultrasounds performed earlier in pregnancy. The diagnosis of microcephaly may be made at birth or later in infancy. The head circumference of a baby with microcephaly is much smaller than normal. During the physical examination, the physician obtains a complete prenatal and birth history of the child. In older babies and children, the physician may also ask if there is a family history of microcephaly or other medical problems. The physician will also ask about developmental milestones since microcephaly can be associated with other problems, such as mental retardation. Developmental delays may require further medical follow up for underlying problems.

A measurement of the circumference of the child's head is taken and compared to a scale that can identify normal and abnormal ranges.

Diagnostic tests that may be performed to confirm the diagnosis of microcephaly and identify abnormalities in the brain include:

• Head circumference - this measurement is compared with a scale for normal growth and size.
• X-ray - a diagnostic test which uses electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Computerized tomography scan (Also called a CT or a CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
• Blood tests
• Urine tests

Life-long considerations for a child with microcephaly

There is no treatment for microcephaly that will return the baby's head to a normal size or shape. Since microcephaly is a life-long condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his/her self-esteem and promote as much independence as possible.

The full extent of the problem is usually not completely understood immediately after birth, but may be revealed as the child grows and develops.

Children born with microcephaly require frequent examinations and diagnostic testing by their physician to monitor the development of the head as the child grows. The medical team works hard with the child's family to provide education and guidance to improve the health and well being of the child.

Genetic counseling may be recommended by the physician to provide information on the recurrence risks for the disorder and any available testing.