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Birth injury to the spinal cord
Insights
Birth injury to the spinal cord in infants can lead to severe paralysis and death. However, some children with spinal cord injuries can achieve mobility and integrate into society.
Area of Science:
- Pediatrics
- Neurology
- Neonatology
Background:
- Birth injuries to the spinal cord are rare but can have devastating consequences for newborns.
- Previous studies have documented cases, but long-term outcomes for affected children are not well-established.
Purpose of the Study:
- To review 11 cases of pediatric spinal cord birth injuries from 1960-1970.
- To compare these cases with approximately 200 previously published cases.
- To analyze the clinical presentation, diagnosis, and long-term outcomes of these injuries.
Main Methods:
- Retrospective review of 11 pediatric spinal cord birth injury cases.
- Comparison with existing literature data.
- Clinical assessment and follow-up of surviving patients.
Main Results:
- Most infants (8/11) presented with breech or footling presentation.
- Difficult extraction and primary asphyxia were common (9/11).
- Diagnosis was based on flaccid paralysis, sensory deficits, and autonomic dysfunction, confirmed by autopsy or follow-up.
- Mortality was high in the first three years (4/11), primarily due to pneumonia.
- Surviving children (5/6) achieved ambulation with crutches and good psychosocial integration by age 10-18.
Conclusions:
- Pediatric spinal cord birth injuries often result from difficult deliveries and asphyxia.
- Despite severe initial deficits, long-term survival and functional recovery are possible with appropriate care.
- Early diagnosis and management are crucial for improving outcomes in these rare cases.
Abstract:
11 cases of children with birth injury to the spinal cord born between 1960 and 1970 are presented in review and compared to about 200 previously published cases. 8 children presented at delivery with one or both feet and 2 with breech. 9 of these infants were born by difficult extraction and needed resuscitation due to primary asphyxia. One child had an easy vertex delivery without evident risk. Diagnosis was established within the first days of life, based on flaccid motor and sensory paralysis below a defined level, mostly in the cervical or upper thoracic spine, with bladder and bowel paralysis, and confirmed by autopsy or by follow-up study. One child with disruption of the spinal cord above C4 survived only a few hours despite artificial ventilation. 4 children died within the first three years of life, 3 of them due to acute pneumonia. 5 of 6 surviving children were followed regularly and are now 10 to 18 years old. They are ambulant with crutches and are well integrated in their families. 4 children attend normal school, and one girl gets special training for mentally retarded children.