Spinal cord injury at birth: diagnostic and prognostic data in twenty-two patients.
OBJECTIVE
To establish criteria, evident soon after birth, that predict long-term outcome of neonates with spinal cord injury (SCI) at birth.


METHODS
Retrospective case-series.


METHODS
Five Canadian regional neonatal tertiary care centers.


METHODS
Consecutive samples of patients referred to five centers for a total of 22 subjects, in whom SCI was diagnosed during life. Sites of lesions were above the fourth cervical vertebrae (n = 14), at the fourth cervical to the fourth thoracic vertebrae (n = 6), and at the thoracolumbar region (n = 2).


RESULTS
All 14 patients with upper cervical SCI had cephalic presentations, whereas all 6 patients with cervicothoracic SCI had breech presentations (p < 0.0001). The site and extent of lesion were best diagnosed by clinico-imaging correlations. Ultrasonography appeared to be the most useful imaging study. In patients with upper cervical SCI who had no coexistent central nervous system abnormality associated with early death, long-term outcome in survivors (dependency on mechanical ventilation and on aids for upper limb activity and for ambulation) was best predicted by age when breathing was first observed and by rate of recovery of limb motor function in the first 3 months. The presence of breathing movements on day 1 (n = 2) was associated with mild disability. The absence of breathing movements on day 1 and little or no recovery of motor function in the first 3 months was associated with permanent total dependency on mechanical ventilation and severe quadriplegia (n = 5). Apnea on day 1 and intermediate recovery rates in the first 3 months was associated with variable long-term prognoses (n = 3).
MacKinnon
J A
JA
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Perlman
M
M
Kirpalani
H
H
Rehan
V
V
Sauve
R
R
Kovacs
L
L
D001720:Birth Injuries / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography