Neuromuscular problems of the critically ill neonate and child.

This review presents insights gained over 24 years of clinical and laboratory evaluations of children, newborn to 18 years of age, who present with acute weakness in the intensive care setting. The differential diagnosis of neuromuscular disorders in these cases begins with recognition of three categories-the infant and toddler, the older child and adolescent, and the child with critical illness-within which predisposition to specific disorders may be identified. Disorders originating from anterior horn cell, peripheral nerve, neuromuscular junction, and muscle cell are discussed with emphasis on presentation and electrophysiologic findings. Nerve conduction studies, electromyography, electroencephalography, cerebrospinal fluid analysis, and magnetic resonance imaging each play important diagnostic roles in the differentiation of neuromuscular disorders in the critically ill child. Case studies suggest the wide range of presentations these disorders may make to the pediatrician or pediatric neurologist.