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Spinal cord insults in the prenatal, perinatal, and neonatal periods
M Ruggieri1, A K Smárason, M Pike
1Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
Insights
Spinal cord insults (SCI) in infants are rare, diverse, and often underdiagnosed. This study highlights varied causes, presentations, and outcomes, with boys more susceptible to these neonatal neurological conditions.
Area of Science:
- Pediatric Neurology
- Neonatology
- Developmental Neuroscience
Background:
- Spinal cord insults (SCI) occurring in the pre-, peri-, and neonatal periods are uncommon but can lead to significant long-term disability.
- Understanding the features of SCI in this vulnerable population is crucial for accurate diagnosis and management.
- Existing data on the characteristics and outcomes of neonatal SCI is limited.
Purpose of the Study:
- To investigate the diverse features of spinal cord insults in children during the pre-, peri-, and neonatal periods.
- To analyze the timing, nature, level, aetiology, clinical presentation, and outcomes of these SCI cases.
- To identify potential risk factors and patterns associated with neonatal SCI.
Main Methods:
- A questionnaire-based survey was distributed to pediatric neurologists, urologists, and neonatologists across the UK and Ireland.
- Data collected included patient demographics, maternal and birth history, SCI characteristics, clinical findings, imaging, and outcomes.
- Analysis focused on 51 eligible patients with SCI born between 1972 and 1996, excluding pure dysraphic cord syndromes.
Main Results:
- Fifty-one patients with SCI were identified, with lesions predominantly cervical (N=22) or thoraco-lumbar (N=29).
- Common presentations included severe respiratory failure (N=20) and hypotonia/weakness (N=22). Aetiologies were varied, with 24 cases of unknown origin.
- Lower mean gestational age and birthweight were noted, particularly in thoraco-lumbar and ischemic lesions. Males were more affected than females.
Conclusions:
- Neonatal spinal cord insults are rare, heterogeneous, and likely underdiagnosed, presenting a wide spectrum of clinical features and outcomes.
- Factors such as preterm delivery, multiple pregnancy, and assisted delivery methods were more common.
- Outcomes varied significantly, including motor deficits, sphincter dysfunction, scoliosis, and neurodevelopmental issues, underscoring the need for early recognition and intervention.
Abstract:
We investigated the features of children with spinal cord insults (SCI) occurring in the pre-, peri-, and neonatal periods by sending 340 questionnaires to all paediatric neurologists, paediatric urologists, and neonatologists in the UK and Ireland. We requested information about timing, nature, and level of SCI in their patients; family and maternal history; pregnancy, delivery, and neonatal period; clinical presentation, imaging, laboratory studies, and outcome. Two-hundred and sixty-one questionnaires were returned with data on 58 patients with SCI. Seven out of the 58 children with SCI had pure dysraphic cord syndromes and were excluded. Fifty-one patients (33 males, 17 females, one unknown), born between 1972 and 1996, remained. Clinical presentations included severe respiratory failure (N=20; five of whom died neonatally) and hypotonia or weakness recognized either during the neonatal period (N=12) or after 28 days (N=10). Data on clinical presentation were not given in nine cases. Lesions were cervical (N=22) and thoraco-lumbar (N=29). SCI was ascribed to ischaemia (N=12), trauma (N=4), and other associated underlying conditions (N=11), whilst the aetiology was unknown in 24 cases. Mean gestational age (36.2 weeks) and birthweight (2.6 kg) were lower than previously reported with the lowest figures associated with thoraco-lumbar and ischaemic lesions. More males were affected by lesions than females and the incidence of preterm delivery, multiple pregnancy, breech presentation, forceps delivery, and caesarean delivery were higher than average. Forceps delivery was associated with cervical lesions. Outcome data were given in 47 children, nine of whom died either neonatally or within the first 20 months of life. Motor disability ranged from a complete recovery in one out of 40 to paraparesis in 26 out of 40, and tetraparesis in 13 out of 40 patients: 17 out of 39 were ambulant. Sphincter dysfunction was present in 22 out of 38 patients and scoliosis in 16 out of 37. Learning difficulties were present in 10 out of 39, behavioural problems in five out of 39 and seizures in four out of 39 patients. SCI in the pre-, peri-, and neonatal periods are rare but probably under-diagnosed and are heterogeneous in aetiology, presentation, and outcome. Boys appear to be more susceptible than girls.