Spinal cord insults in the prenatal, perinatal, and neonatal periods

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.

Congenital Cervical Spinal Cord Lesions: Pathogenesis, Management, and Outcome

“…Perinatal asphyxia leading to diffuse hypoxic-ischemic insults to the spinal cord and brain are common events. 2 Focal ischemic lesions of the cord in isolation, especially following an atraumatic delivery, are described but are more unusual 3 (Table 1 [4][5][6][7][8] ).…”

“…Table 2 summarizes patients in the literature with spinal cord insults occurring in the prenatal, perinatal, and postnatal periods. [2][3][4][9][10][11][12][13][14] Patient 1 had the most severe phenotype. His segmental thinning of the cervical spine region was reported in other studies.…”

“…Focal ischemic lesions of the cord in isolation, especially following an atraumatic delivery, are more unusual. 2 We describe 3 infants with congenital cervical spinal cord lesions and discuss their diverse pathogeneses and outcomes.…”

Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report

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orms of intrauterine or perinatal spinal cord injury (SCI) related to fetal position and birth trauma have been described extensively. [1][2][3][4][5][6][7][8][9][10][11] However, intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, 12 and there is minimal evidence describing outcomes in this population, especially functional therapeutic outcomes. [13][14][15][16][17][18] Literature describing IUSCI is mainly limited to early medical intervention as most individuals affected do not survive early infancy.

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