Spinal cord transection, cerebral ischaemic and brain-stem injury in a baby following a Kielland's forceps rotation

Unusual Presentations of Birth Related Cervical Spinal Cord Injury

Neonatal spinal cord injury is a rare complication of birth trauma by difficult delivery. The typical manifestations are often catastrophic, include decreased or absent movement, loss of reflexes, apnea or periodic breathing, and a lack of response to painful stimulation. The outcome is usually fatal or severe, with long-term sequelae of respiratory insufficiency, limb weakness, or even paralysis of the limbs. We described a male neonate with a C2 spinal cord injury who was born smoothly by vaginal delivery and was unnoticed initially due to unusual subtle symptoms. He presented with a hoarse voice, swallowing dysfunction, decreased movement of upper limbs, and hypercapnia. After receiving corticosteroid therapy and rehabilitation, he recovered much except that he still needed ventilator support at night.

Neonatal diagnosis of spinal cord transection

Cervical spinal cord injury is an uncommon clinical entity in the present day. Transection of the spinal cord was first recognized as a clinical entity in 1870, after Parrot described this insult following a breech delivery.1 In the early 20th century, there were multiple reports of spinal injury at birth, all diagnosed at autopsy. We report the earliest case to date of an infant with a cervical spinal cord transection diagnosed by magnetic resonance imaging (MRI).