{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:18:29Z","timestamp":1779164309571,"version":"3.51.4"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Our aim was to develop a new module for assessing the floppy infant, to describe the application of the module in a cohort of low-risk newborns and piloting the module in a cohort of floppy infants. The module was applied to a cohort of 143 low-risk newborns and piloted in in a cohort of 24 floppy infants. The new add-on module includes a neurological section and provides a section for recording information obtained by physical examination and antenatal history. For each item, column 1 reports abnormal findings, column 3 normal findings, and column 2 intermediate signs to be followed. Consistent with previous studies, in low-risk infants, none had definitely abnormal or mildly abnormal signs, with the exception of tendon reflexes that were not easily elicitable in 17.14% of term-born infants.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Our study suggest that the module can be easily used in a clinical setting as an add-on to the regular neonatal neurological examination in newborns identified as hypotonic on routine examination. Larger cohorts are needed to establish the accuracy of the prognostic value of the module in the differential diagnosis of floppy infant.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022\u00a0Hypotonia is one of the key signs in newborns with neuromuscular disorders and can be associated with a wide range of other conditions (central nervous system involvement, genetic and metabolic diseases).<\/jats:italic><jats:italic>\u2022 Weakness or\/and contractures can identify infants with a neuromuscular disorder and help in the differential diagnosis of floppy infants.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022\u00a0To date, this is the first attempt to develop and apply a specific neurological module for the assessment of the floppy infant.<\/jats:italic><jats:italic>\u2022 The module can be used in a routine clinical setting as an add-on to the regular neurological examination and has potential to differentiate the floppy infants from the low-risk infants.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04476-x","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T01:02:15Z","timestamp":1651626135000},"page":"2771-2778","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Assessing floppy infants: a new module"],"prefix":"10.1007","volume":"181","author":[{"given":"Costanza","family":"Cutrona","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Pede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"De Sanctis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Coratti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eloisa","family":"Tiberi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Luciano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carmela","family":"Pera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Velli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Capasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Vento","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico M.","family":"Romeo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marika","family":"Pane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Mercuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"4476_CR1","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/j.1469-8749.1968.tb02967.x","volume":"10","author":"V Dubowitz","year":"1968","unstructured":"Dubowitz V (1968) The floppy infant\u2013a practical approach to classification. Dev Med Child Neurol 10:706\u2013710","journal-title":"Dev Med Child Neurol"},{"key":"4476_CR2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jpeds.2004.08.047","volume":"146","author":"I Vasta","year":"2005","unstructured":"Vasta I, Kinali M, Messina S, Guzzetta A, Kapellou O, Manzur A, Cowan F, Muntoni F, Mercuri E (2005) Can clinical signs identify newborns with neuromuscular disorders? J Pediatr 146:73\u201379","journal-title":"J Pediatr"},{"key":"4476_CR3","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/j.1469-8749.2011.03918.x","volume":"53","author":"EC Lisi","year":"2011","unstructured":"Lisi EC, Cohn RD (2011) Genetic evaluation of the pediatric patient with hypotonia: perspective from a hypotonia specialty clinic and review of the literature. Dev Med Child Neurol 53:586\u2013599","journal-title":"Dev Med Child Neurol"},{"key":"4476_CR4","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/S0387-7604(03)00066-4","volume":"25","author":"AN Prasad","year":"2003","unstructured":"Prasad AN, Prasad C (2003) The floppy infant: contribution of genetic and metabolic disorders. Brain Dev 25:457\u2013476","journal-title":"Brain Dev"},{"key":"4476_CR5","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s00431-007-0539-3","volume":"167","author":"V Laugel","year":"2008","unstructured":"Laugel V, Cossee M, Matis J, de Saint-Martin A, Echaniz-Laguna A, Mandel JL, Astruc D, Fischbach M, Messer J (2008) Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr 167:517\u2013523","journal-title":"Eur J Pediatr"},{"issue":"363\u2013371","key":"4476_CR6","first-page":"ix","volume":"42","author":"SE Sparks","year":"2015","unstructured":"Sparks SE (2015) Neonatal hypotonia. Clin Perinatol 42(363\u2013371):ix","journal-title":"Clin Perinatol"},{"key":"4476_CR7","doi-asserted-by":"crossref","unstructured":"Sharma S, Repnikova E, Noel-MacDonnell JR, LePichon JB (2021) Diagnostic yield of genetic testing in 324 infants with hypotonia. Clin Genet","DOI":"10.1111\/cge.14057"},{"key":"4476_CR8","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/B978-0-444-64029-1.00021-7","volume":"162","author":"E Mercuri","year":"2019","unstructured":"Mercuri E, Pera MC, Brogna C (2019) Neonatal hypotonia and neuromuscular conditions. Handb Clin Neurol 162:435\u2013448","journal-title":"Handb Clin Neurol"},{"key":"4476_CR9","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.nmd.2015.03.011","volume":"25","author":"M Savarese","year":"2015","unstructured":"Savarese M, Di Fruscio G, Tasca G, Ruggiero L, Janssens S, De Bleecker J, Delpech M, Musumeci O, Toscano A, Angelini C, Sacconi S, Santoro L, Ricci E, Claes K, Politano L, Nigro V (2015) Next generation sequencing on patients with LGMD and nonspecific myopathies: findings associated with ANO5 mutations. Neuromuscul Disord 25:533\u2013541","journal-title":"Neuromuscul Disord"},{"key":"4476_CR10","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1212\/WNL.0000000000002800","volume":"87","author":"M Savarese","year":"2016","unstructured":"Savarese M, Di Fruscio G, Torella A, Fiorillo C, Magri F, Fanin M, Ruggiero L et al (2016) The genetic basis of undiagnosed muscular dystrophies and myopathies: Results from 504 patients. Neurology 87:71\u201376","journal-title":"Neurology"},{"key":"4476_CR11","doi-asserted-by":"crossref","unstructured":"Cummings BB, Marshall JL, Tukiainen T, Lek M, Donkervoort S, Foley AR, Bolduc V et al (2017) Improving genetic diagnosis in Mendelian disease with transcriptome sequencing. Sci Transl Med 9","DOI":"10.1126\/scitranslmed.aal5209"},{"key":"4476_CR12","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1001\/jamaneurol.2015.2274","volume":"72","author":"R Ghaoui","year":"2015","unstructured":"Ghaoui R, Cooper ST, Lek M, Jones K, Corbett A, Reddel SW, Needham M, Liang C, Waddell LB, Nicholson G, O\u2019Grady G, Kaur S, Ong R, Davis M, Sue CM, Laing NG, North KN, MacArthur DG, Clarke NF (2015) Use of whole-exome sequencing for diagnosis of limb-girdle muscular dystrophy: outcomes and lessons learned. JAMA Neurol 72:1424\u20131432","journal-title":"JAMA Neurol"},{"key":"4476_CR13","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/S0022-3476(98)70279-3","volume":"133","author":"L Dubowitz","year":"1998","unstructured":"Dubowitz L, Mercuri E, Dubowitz V (1998) An optimality score for the neurologic examination of the term newborn. J Pediatr 133:406\u2013416","journal-title":"J Pediatr"},{"key":"4476_CR14","doi-asserted-by":"crossref","unstructured":"Pane M, Donati MA, Cutrona C, De Sanctis R, Pirinu M, Coratti G, Ricci M, Palermo C, Berti B, Leone D, Ticci C, Sacchini M, Cerboneschi M, Capasso A, Cicala G, Pera MC, Bravetti C, Abiusi E, Vaisfeld A, Vento G, Tiziano FD, Mercuri E (2022) Neurological assessment of newborns with spinal muscular atrophy identified through neonatal screening. Eur J Pediatr in press","DOI":"10.1007\/s00431-022-04470-3"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-022-04476-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-022-04476-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-022-04476-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T05:25:50Z","timestamp":1662787550000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-022-04476-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,4]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["4476"],"URL":"https:\/\/doi.org\/10.1007\/s00431-022-04476-x","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,4]]},"assertion":[{"value":"8 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2022","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Missing Open Access funding information has been added in the Funding Note.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the ethics committee of our center (Policlinico Agostino Gemelli, Rome).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from the parents of all participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Informed consent was obtained from the parents of all participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"De Sanctis R reports personal fees from Biogen S.R.L. Italia, AveXis, and Novartis outside the submitted work; Coratti G reports personal fees from Biogen S.R.L. Italia, Roche, Genesis Pharma, AveXis, Novartis, and Biologix, outside the submitted work; Pera MC reports personal fees from Roche outside the submitted work; Pane M reports personal fees from Biogen S.R.L., PTC, AveXis, Novartis, and Sarepta, outside the submitted work; Mercuri E reports personal fees from AveXis, Novaris, Roche, Biogen S.R.L., PTC Therapeutics, Sarepta, and Santhera, outside the submitted work; Cutrona C, Pede E, Tiberi E, Luciano R, Velli C, Capasso A, Vento G, and Romeo DM have nothing to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}