Cry, high-pitched [Cerebral cry]
Cry, high-pitched [Cerebral cry]: Excerpt from Handbook of Signs & Symptoms (Third Edition)
A high-pitched cry is a brief, sharp, piercing vocal sound produced by a neonate or infant. Whether acute or chronic, this cry is a late sign of increased intracranial pressure (ICP). The acute onset of a high-pitched cry demands emergency treatment to prevent permanent brain damage or death.
A change in the volume of one of the brain's components — brain tissue, cerebrospinal fluid, and blood — may cause increased ICP. In neonates, increased ICP may result from intracranial bleeding associated with birth trauma or from congenital malformations, such as craniostenosis and Arnold-Chiari deformity. In fact, a high-pitched cry may be an early sign of a congenital malformation. In infants, increased ICP may result from meningitis, head trauma, or child abuse.
History and physical examination
Take the infant's vital signs, and then obtain a brief history. Did the infant fall recently or experience even minor head trauma? Make sure to ask the mother about changes in the infant's behavior during the past 24 hours. Has he been vomiting? Has he seemed restless or unlike himself? Has his sucking reflex diminished? Does he cry when he's moved? Suspect child abuse if the infant's history is inconsistent with physical findings.
Next, perform a neurologic examination. Remember that neurologic responses in a neonate or young infant are primarily reflex responses. Determine the infant's level of consciousness (LOC). Is he awake, irritable, or lethargic? Does he reach for an attractive object or turn toward the sound of a rattle? Observe his posture. Is he in the normal flexed position or in extension or opisthotonos? Examine muscle tone and observe the infant for signs of seizure, such as tremors and twitching.
Examine the size and shape of the infant's head. Is the anterior fontanel bulging? Measure the infant's head circumference, and check pupillary size and response to light. Unilateral or bilateral dilation and a sluggish response to light may accompany increased ICP. Finally, test the infant's reflexes; expect Moro's reflex to be diminished.
After completing your examination, elevate the infant's head to promote cerebral venous drainage and decrease ICP. Start an I.V. line, and give a diuretic and a corticosteroid to decrease ICP. Be sure to keep endotracheal (ET) intubation equipment close by to secure an airway.
Medical causes
Increased ICP.
A high-pitched cry is a late sign of increased ICP. Typically, the infant also displays bulging fontanels, increased head circumference, and widened sutures. Earlier signs and symptoms of increasing ICP include seizures, bradycardia, possible vomiting, dilated pupils, decreased LOC, increased systolic blood pressure, a widened pulse pressure, and an altered respiratory pattern.
Special considerations
The infant with increased ICP requires specialized care and monitoring in the intensive care unit. For example, you'll need to monitor his vital signs and neurologic status to detect subtle changes in his condition. Also, monitor his intake and output. Monitor ICP, restrict fluids, and administer a diuretic. Increase the head of the bed 30 degrees, if the condition permits, and keep the head midline. Perform nursing care judiciously because procedures may cause a further increase in ICP. For an infant with severely increased ICP, ET intubation and mechanical hyperventilation may be needed to decrease serum carbon dioxide levels and constrict cerebral blood vessels. Hyperventilation is used for acute increases in ICP, the risks and benefits of which must be carefully weighed. Alternatively, barbiturate coma or hypothermia therapy may be needed to decrease the infant's metabolic rate.
Remember to avoid jostling the infant, which may aggravate increased ICP. Comfort him and maintain a calm, quiet environment because the infant's crying or exposure to environmental stimuli may also worsen increased ICP.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Cry, high-pitched [Cerebral cry] (Professional Guide to Signs & Symptoms (Fifth Edition))
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