Spinal cord injury at birth: a hidden causative factor.
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 Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements.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.


CONCLUSIONS
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.
Fenger-Gron
Jesper
J
Department of Pediatrics, Odense University Hospital, Denmark. jfg@grejsdalen.dk
Kock
Kirsten
K
Nielsen
Rasmus G
RG
Leth
Peter M
PM
Illum
Niels
N
D001720:Birth Injuries / Q000150:complications* / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors; D028761:Withholding Treatment