1
|
Gowda S, Chandra P, Sharma DM, Kamath L, V M. Hypoxic Ischemic Encephalopathy with Cervical Spinal Cord Injury: A Diagnostic Dilemma. Indian J Pediatr 2024; 91:191-192. [PMID: 37782391 DOI: 10.1007/s12098-023-04872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
Perinatal spinal cord injury is a relatively uncommon, but a frequently misdiagnosed disorder. Improvements in obstetric care have certainly led to a decrease in the incidence of birth related spinal cord trauma but unfortunately the incidence of hypoxic-ischemic encephalopathy is still very high. The exact incidence of spinal cord trauma is difficult to determine because the spinal cord is not routinely examined in far and few neonatal autopsies done in India. Here, authors present a neonate who received treatment for birth asphyxia and then had extubation failure which made the clock tick towards cervical cord injury. This baby had a hemorrhagic contusion of cervical spinal cord.
Collapse
Affiliation(s)
- Suresh Gowda
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Prathap Chandra
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Deepa Mohan Sharma
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Laxmi Kamath
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India.
| | - Mamatha V
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| |
Collapse
|
2
|
Lee CC, Chou IJ, Chang YJ, Chiang MC. Unusual Presentations of Birth Related Cervical Spinal Cord Injury. Front Pediatr 2020; 8:514. [PMID: 33117760 PMCID: PMC7550748 DOI: 10.3389/fped.2020.00514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Chien-Chung Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,School of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - I-Jun Chou
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Jung Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,School of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
3
|
Abstract
Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.
Collapse
Affiliation(s)
- Tiffany McKee-Garrett
- Baylor College of Medicine, Department of Pediatrics, Section of Neonatology, Houston, TX, USA.
| |
Collapse
|
4
|
Billingham C, Richardson R, Lilien L. Breech delivery, rupture of Batson's plexus, T8 epidural hematoma, and paraplegia. J Neonatal Perinatal Med 2019; 12:325-331. [PMID: 30932899 DOI: 10.3233/npm-180080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A male newborn born by an atraumatic vaginal frank breech delivery was noted to have normal limb movement at birth. However, at 24 hours the neonate developed paraplegia with no evidence of spinal cord injury on radiographic films. Ultrasound and MRI demonstrated an epidural hematoma at the level of T8 and distal cord edema which extended to the conus medullaris. Delayed onset paraplegia following an atraumatic vaginal breech delivery is unlikely to have been caused by acute traction or torsion at birth. Traction and torsion injuries would present acutely. This infant developed a T8 epidural hematoma which has not been reported in a newborn. The pathophysiology of a spontaneous spinal epidural hematoma (SSEH) in adults is frequently related to increased abdominal/thoracic pressure which results in increased pressure in the highly anastomotic network of thin walled and valve-less vertebral venous plexus (Batson's plexus). Such increase in abdominal/thoracic pressure could occur during a frank breech delivery and result in a slow onset epidural hematoma. This report highlights the importance of considering slow onset epidural hematoma in the differential diagnosis of neonates who develop slow onset paraplegia. If diagnosed quickly, an epidural hematoma represents a potentially treatable etiology by rapid surgical decompression.
Collapse
Affiliation(s)
- C Billingham
- Creighton University School of Medicine Phoenix Regional Campus, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - R Richardson
- Creighton University School of Medicine Phoenix Regional Campus, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - L Lilien
- Creighton University School of Medicine Phoenix Regional Campus, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| |
Collapse
|
5
|
Felter CE, Neuland EE, Iuculano SC, Dean J. Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report. Top Spinal Cord Inj Rehabil 2019; 25:97-103. [PMID: 30774293 DOI: 10.1310/sci18-00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI.
Collapse
Affiliation(s)
- Cara E Felter
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Erin E Neuland
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Shannon C Iuculano
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Janet Dean
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| |
Collapse
|
6
|
Gopinathan NR, Viswanathan VK, Crawford AH. Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts. Indian J Orthop 2018; 52:489-500. [PMID: 30237606 PMCID: PMC6142799 DOI: 10.4103/ortho.ijortho_607_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total. Three hundred and forty three articles were considered for the review after eliminating unrelated and duplicate articles. Further screening was performed and 67 articles (original articles and review articles only) related to pediatric CSI were finally included. All articles were reviewed for details regarding epidemiology, injury patterns, anatomic considerations, clinical, and radiological evaluation protocols. CSIs are the most common level (60%-80%) for pediatric Spinal Injuries (SI). Children suffer from atlantoaxial injuries 2.5 times more often than adults. Children's unique anatomical features (large head size and highly flexible spine) predispose them to such a peculiar presentation. The role of National Emergency X-Ray Utilization Study, United State (NEXUS) and Canadian Cervical Spine Rule criteria in excluding pediatric cervical injury is questionable but cannot be ruled out completely. The minimum radiological examination includes 2- or 3-view cervical X-rays (anteroposterior, lateral ± open-mouth odontoid views). Additional radiological evaluations, including computerized tomography (CT) and magnetic resonance imaging (MRI) are obtained in situations of abnormal physical examination, abnormal X-rays, inability to obtain adequate X-rays, or to assess cord/soft-tissue status. The clinical criteria for cervical spine injury clearance can generally be applied to children older than 2 years of age. Nevertheless, adequate caution should be exercised before applying these rules in younger children. Initial radiographic investigation should be always adequate plain radiographs of cervical spine. CT and MRI scans should only be performed in an appropriate group of pediatric patients.
Collapse
Affiliation(s)
- Nirmal Raj Gopinathan
- Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vibhu Krishnan Viswanathan
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alvin H Crawford
- Department of Pediatric Orthopedics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| |
Collapse
|
7
|
Spinal cord infarction in a sick neonate from predominant haemorrhagic aetiology: a case report. Spinal Cord Ser Cases 2017; 3:17038. [PMID: 28690873 DOI: 10.1038/scsandc.2017.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/27/2017] [Accepted: 05/30/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Spinal cord injuries in new born infants following a traumatic delivery or umbilical cord catheterisation due to thromboembolism are well known. Cases with atraumatic acute onset of neonatal paraplegia have also been described in preterm babies or babies born small for gestational age with a stormy postnatal course related to ischaemic aetiology. We describe a rare case of infarction of the spinal cord from a predominant haemorrhagic aetiology. CASE PRESENTATION A term female baby, first child of unrelated parents, was born by normal vaginal delivery. She had meconium aspiration at birth, leading to severe respiratory distress, requiring neonatal intensive care admission. At 2 weeks, she developed new flaccid paraplegia. MRI scan of the spine showed haemorrhagic infarction of the spinal cord from the level of thoracic inlet, vertebral level C7-T1. A follow-up MRI scan at 11 months revealed severe atrophy of the cord distal to C6. At 3 years of age, she had good upper-limb function, diaphragmatic breathing and flaccid paralysis of lower limbs. DISCUSSION In an acutely unwell term infant with symptoms of paralysis or spinal cord damage, haemorrhagic infarction needs to be considered in the differential diagnosis. To our knowledge, this is the first reported case of spinal cord injury in a term infant with a haemorrhagic lesion, and it helps to understand the pathogenesis of nontraumatic insult.
Collapse
|
8
|
Yokoi K, Kobayashi S, Muramatsu K, Suzuki S, Gotou H. The question of whether or not to perform therapeutic hypothermia: A case of neonatal spinal cord injury. J Neonatal Perinatal Med 2017; 10:195-198. [PMID: 28409761 DOI: 10.3233/npm-171695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neonatal spinal cord injury is an extremely rare perinatal complication that often occurs concurrently with hypoxic ischemic encephalopathy (HIE), further complicating diagnosis of spinal cord injury. Although therapeutic hypothermia for moderate to severe HIE is widely recommended in Japan, it is difficult to determine whether it satisfies the neurological findings-related entry criteria in some patients.We describe a female infant with neonatal spinal cord injury after forceps delivery, who underwent therapeutic hypothermia upon diagnosis of HIE. The Apgar scores were 5 at 1 min, 6 at 5 min, and not recorded at 10 min. Blood gas analysis of her umbilical artery was not performed. Since respiratory failure, hypotonia and the absence of primitive reflexes were found at 2 hours after birth, she was initially diagnosed with moderate HIE and underwent a therapeutic hypothermia. Magnetic resonance imaging after therapeutic hypothermia revealed the spinal cord was narrowed from the lower medulla oblongata to the upper cervical cord. Thus she was diagnosed with an upper spinal cord injury at that time.Some patients with neonatal spinal cord injuries satisfy the criteria for therapeutic hypothermia. When neonates with asphyxia present with prolonged respiratory failure and hypotonia, spinal cord injury should be considered in the differential diagnosis. Thus, an early MRI is vital for the diagnosis of spinal cord injury.
Collapse
|
9
|
Fazzi A, Messner H, Stuefer J, Staffler A. Neonatal spinal cord injury after an uncomplicated caesarean section. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2015-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction: Spinal cord injury of the newborn is a rare and critical condition which is typically reported after difficult deliveries. The few cases of spinal cord injury after caesarean section reported in literature are usually associated with intrauterine hyperextension of the head. However, in exceptional cases the authors described intrauterine vascular insults as a possible cause for spinal cord lesions during pregnancy.
Presentation of the case: A term infant was born after an uncomplicated caesarean section following cephalic presentation. Pregnancy was reported as uneventful. Foetal ultrasounds were normal and showed no evidence of hyperextension of the head. Although the boy was in good general conditions after birth, he showed a flaccid paralysis of both upper extremities with absent deep tendon reflexes and missing pain response. Other neurologic findings like general tonus and reactivity as well as spontaneous movements of both lower extremities were adequate. A spinal MRI performed at 48 h of life showed intact brachial plexuses with evidence of spinal cord lesion compatible with an ischemic injury. Accurate anamnesis revealed that the mother had perceived reduced foetal movements in the last 2 days before birth, suggesting a possible intrauterine origin of the ischaemic event.
Conclusion: Our case reinforces the hypothesis that small ischaemic spinal cord lesions may occur during uncomplicated pregnancy. Therefore, such lesions may not always be related to a difficult delivery. Irrespective of the cause, treatment and parental counselling remain challenging due to the rarity of reported cases.
Collapse
Affiliation(s)
- Anisia Fazzi
- Department of Neonatolgy, Central Teaching Hospital of Bolzano/Bozen, Italy
| | - Hubert Messner
- Department of Neonatolgy, Central Teaching Hospital of Bolzano/Bozen, Italy
| | - Josef Stuefer
- Department of Radiology, Central Teaching Hospital of Bolzano/Bozen, Italy
| | - Alex Staffler
- Department of Neonatolgy, Central Teaching Hospital of Bolzano/Bozen, Italy
| |
Collapse
|
10
|
Abstract
Despite a greatly decreasing incidence of birth injuries over the past several decades with birth trauma currently accounting for less than 2% of neonatal deaths, birth trauma continues to be a significant cause of morbidity and mortality. Birth trauma is usually recognized by obstetricians and pediatricians, particularly when associated with a difficult delivery; therefore many birth injuries are diagnosed and documented in the neonatal period. Other delivery-related trauma may remain clinically silent without premortem identification. The challenge for the pathologist at autopsy is to correlate a history of birth trauma with injuries seen at autopsy, and to interpret injuries existing at death to accurately include or exclude birth trauma as a potential cause. Recognition of the spectrum of birth trauma is important when considering other accidental and nonaccidental mechanisms of injury, particularly in cases of unwitnessed perinatal death following delivery of a concealed pregnancy or in cases of alleged nonaccidental trauma. Discussed here is a general review of birth trauma that may be seen in a forensic setting to aid in interpretation of injuries that can be encountered.
Collapse
Affiliation(s)
- Kelly C. Lear-Kaul
- Forensic Pathologist at the Arapahoe County (Colorado) Coroner's Office and University of Colorado Anschutz Medical Campus
| |
Collapse
|
11
|
Pape KE. Developmental and maladaptive plasticity in neonatal SCI. Clin Neurol Neurosurg 2012; 114:475-82. [DOI: 10.1016/j.clineuro.2012.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
|
12
|
Vialle R, Piétin-Vialle C, Ilharreborde B, Dauger S, Vinchon M, Glorion C. Spinal cord injuries at birth: A multicenter review of nine cases. J Matern Fetal Neonatal Med 2009; 20:435-40. [PMID: 17674252 DOI: 10.1080/14767050701288325] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report a multicenter study of nine cases of children presenting with a birth-related spinal injury. METHODS The medical charts of nine patients identified by a questionnaire sent to the members of the French Society of Pediatric Orthopedics (SOFOP) were reviewed. RESULTS The pregnancy was uneventful in all cases. The fetal presentation was cephalic in three cases, a breech presentation in four cases, and a face presentation in two cases. The lesion involved the cervical spine in six cases. Three patients presenting upper cervical injuries died before the age of six years. The six remaining patients experienced no neurological improvement. CONCLUSIONS These rare conditions occur during difficult deliveries with abnormal presentations, the most common being a breech presentation with entrapment of the fetal head. In a child with hypotonia, flaccid quadriplegia or high thoracic paraplegia after a difficult delivery, a spinal cord injury must be suspected and plain radiographs and MRI must be performed.
Collapse
Affiliation(s)
- Raphaël Vialle
- Department of Pediatric Orthopedics, Université Pierre et Marie Curie-Paris6, Armand Trousseau Hospital, Paris, France.
| | | | | | | | | | | |
Collapse
|
13
|
Nouri-Merchaoui S, Zakhama R, Fekih M, Mahdhaoui N, Methlouthi J, Salem N, Seboui H. [Upper cervical-spinal cord injury complicating a forceps delivery in a macrosomic neonate]. Arch Pediatr 2008; 15:1822-4. [PMID: 18980835 DOI: 10.1016/j.arcped.2008.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 08/17/2008] [Accepted: 09/23/2008] [Indexed: 11/18/2022]
|
14
|
Abstract
UNLABELLED A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co-morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously. CONCLUSION In cases of serious perinatally acquired SCI, claim of malpractice is often apparent. In this case a hidden congenital malformation of the cervical vertebrae was revealed, highlighting the need of careful postmortem examinations in such cases.
Collapse
|
15
|
Vialle R, Piétin-Vialle C, Vinchon M, Dauger S, Ilharreborde B, Glorion C. Birth-related spinal cord injuries: a multicentric review of nine cases. Childs Nerv Syst 2008; 24:79-85. [PMID: 17632726 DOI: 10.1007/s00381-007-0437-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 05/18/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to report a multicentric study of nine cases of children presenting with a birth-related spinal injury. MATERIALS AND METHODS The medical charts of nine patients identified by a questionnaire sent to the members of the French Society of Paediatric Orthopaedics (SOFOP) were reviewed. CONCLUSIONS The pregnancy was uneventful in all cases. The fetal presentation was cephalic in three cases, a breech presentation in four cases, a face presentation in two cases. The lesion involved the cervical spine in six cases. Three patients presenting upper cervical injuries died before the age of 6 years. The six remaining patients experienced no neurological improvement. These rare conditions occur during difficult deliveries with abnormal presentations, the most common being a breech presentation with entrapment of the fetal head. In a child with hypotonia, flaccid quadriplegia or high thoracic paraplegia after a difficult delivery, a spinal cord injury must be suspected and plain radiographs and magnetic resonance imaging (MRI) must be performed.
Collapse
Affiliation(s)
- Raphaël Vialle
- Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris6, Armand Trousseau Hospital, 26, avenue du Docteur Arnold Netter, Paris Cedex 12, 75571, France.
| | | | | | | | | | | |
Collapse
|
16
|
Kobayashi S, Kanda K, Yokochi K, Ohki S. A case of spinal cord injury that occurred in utero. Pediatr Neurol 2006; 35:367-9. [PMID: 17074611 DOI: 10.1016/j.pediatrneurol.2006.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 05/18/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
Spinal cord injury is a rare occurrence that is often difficult to diagnose. This report describes a 2-year-old male with cervicothoracic spinal cord injury. The injury is thought to have occurred in the fetal period because the patient's thorax was markedly hypoplastic at birth and his mother had noticed a decrease in fetal movements for several weeks before the birth. The deep tendon reflex of the upper and lower extremities was absent at birth, as observed in other cases of spinal cord injury. It was noteworthy that deep tendon reflex of the upper and lower extremities remained decreased at 2 years of age despite the injury being located at C(7)-T(1). Based on this case, we propose that spinal cord injuries occurring in utero display different reflex responses from those occurring at birth.
Collapse
Affiliation(s)
- Satoru Kobayashi
- Department of Pediatrics, Seirei-Mikatahara Hospital, Shizuoka, Japan.
| | | | | | | |
Collapse
|
17
|
Parker LA. Part 2: Birth trauma: injuries to the intraabdominal organs, peripheral nerves, and skeletal system. Adv Neonatal Care 2006; 6:7-14. [PMID: 16458246 DOI: 10.1016/j.adnc.2005.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Part 1 of this 2-part article, "Early Recognition and Treatment of Birth Trauma: Injuries to the Head and Face" provided readers with basic concepts related to birth trauma to the head and face. Part 2 focuses on the pathophysiology, etiology, diagnosis, treatment, and prognosis of birth injuries to the intraabdominal organs, the peripheral nerves, the spinal cord, and the skeletal system. Risk factors for birth injury to these areas are discussed along with key issues related to the nursing care of affected infants.
Collapse
Affiliation(s)
- Leslie A Parker
- College of Nursing, University of Florida, Gainesville, FL 32610, USA.
| |
Collapse
|
18
|
Abstract
Neonatal spinal cord injury can occur in utero, as well as after either a difficult delivery or a nontraumatic delivery. Spinal cord injury can also be related to invasive nursery procedures or underlying neonatal pathology. Early clinical signs of spinal cord injury that has occurred in utero or at delivery includes severe respiratory compromise and profound hypotonia. Knowledge of risk factors and awareness of symptoms is required for early recognition and appropriate treatment. This article reviews the embryological development of the spinal column highlighting mechanisms of injury and identifying underlying factors that increase the risk of spinal cord injury in newborns. Signs and symptoms of injury, cervical spine immobilization, and the differential diagnosis are discussed. Nursing implications, general prognosis, and research in spinal cord injury are provided.
Collapse
Affiliation(s)
- M Colleen Brand
- Texas Children's Hospital, University of Texas-Houston School of Nursing, 6901 Bertner Street, Rm. 768, Houston, TX 77030, USA.
| |
Collapse
|
19
|
Caird MS, Reddy S, Ganley TJ, Drummond DS. Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon. J Pediatr Orthop 2005; 25:484-6. [PMID: 15958900 DOI: 10.1097/01.bpo.0000158006.61294.ff] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spinal cord birth injury is rare, and orthopaedic surgeons infrequently encounter it. The injury is associated with hyperextension of the fetal head in utero and during delivery and with forceps-assisted breech vaginal deliveries. These cervical spinal cord injures may be complete or partial. They most commonly occur in the absence of bony injury, which can lead to diagnostic difficulties. Ultrasound and MRI studies are valuable diagnostic tools for identifying spinal cord injury in cases of hypotonic newborns with difficult deliveries. The authors report an unusual case of spinal cord birth injury with frank cervical fracture-dislocation following a difficult footling breech vaginal delivery. Early recognition of hyperextension of the fetal head in utero and planned cesarean section are important prevention methods. While this type of injury is rare, the pediatric orthopedic surgeon must understand its nature and severity to facilitate timely treatment.
Collapse
|
20
|
Abstract
BACKGROUND Injury to the spinal cord is still observed in the neonate. Its prognosis is poor. CASE REPORTS The first neonate was delivered by cesarean section for breech presentation with hyperextension of the neck. She rapidly developed acute respiratory distress and paraplegia. MRI showed spinal cord hemorrhage involving the cervical and upper thoracic cord with rupture of the cord. The patient died a few weeks later. The second neonate was delivered vaginally in breech presentation without any difficulty. She progressively developed tetraplegia evolving into spasticity. MRI showed stretching of cervical spinal cord. The patient later developed sphincter disturbances, repeated urinary and pulmonary infection and severe scoliosis. CONCLUSIONS Early prenatal damage to the spinal cord was possible in the first patient. Ultrasonography could help to evaluate the extent of damage. The condition leads to difficult ethical and therapeutic problems.
Collapse
Affiliation(s)
- A Le Masne
- Service de médecine néonatale, hôpital Calmette, CHRU, Lille
| | | | | |
Collapse
|