Craniosynostosis and Fontanelle Closure

Developmental Screening and Associated Risks

Developmental screening is essential for children with congenital heart disease (CHD) and other conditions associated with early fontanelle closure, as they may have higher rates of developmental delays, according to the American Heart Association 1
Children with persistent open fontanels at 15 months should undergo brain MRI as the preferred initial imaging modality, due to its lack of radiation exposure, superior visualization of brain parenchyma, and ability to detect subtle abnormalities that may cause increased intracranial pressure, as recommended by the American College of Radiology 2
Ultrasound is not a sufficient sole imaging modality for evaluating open fontanels due to its limitations, including limited sensitivity for small subdural hematomas, poor visualization of posterior fossa, and inadequate detection of small extra-axial hemorrhages 3
Management of open anterior fontanel depends on the underlying cause and may include neurosurgical consultation, CSF diversion procedures if hydrocephalus is present, and anticoagulation if venous sinus thrombosis is diagnosed, according to the American Academy of Pediatrics and other medical societies 4
Certain conditions, such as hypothyroidism, rickets, and osteogenesis imperfecta, can delay fontanel closure, and appropriate laboratory testing, including thyroid function tests, calcium, phosphorus, alkaline phosphatase, and vitamin D levels, should be performed to determine the underlying cause 4

Brain MRI is the preferred initial imaging modality for evaluating persistent open fontanels at 15 months, with advantages including no radiation exposure and superior visualization of brain parenchyma 2
Ultrasound has significant limitations as an imaging modality for evaluating open fontanels, including limited sensitivity and poor visualization of certain areas 3

Management of open anterior fontanel depends on the underlying cause and may include neurosurgical consultation, CSF diversion procedures, and anticoagulation, according to the American Academy of Pediatrics and other medical societies 4
Laboratory testing, including thyroid function tests, calcium, phosphorus, alkaline phosphatase, and vitamin D levels, should be performed to determine the underlying cause of delayed fontanel closure 4