6260 Cervical spinal cord injury in a term neonate

Objectives Spinal cord injury (SCI) is a rare and underdiagnosed condition that can occur in utero, at birth because of difficult delivery and even in the nursery setting after birth. The clinical presentations can be catastrophic, including severe respiratory distress and apnea requiring ventilatory support, sequelae of respiratory insufficiency, limb weakness, or paralysis of the limbs. The overall outcome for spinal cord injury is poor with a high morbidity and mortality. Spinal cord injury should be considered in any newborn with poor tone and respiratory effort at birth with or without a history of difficult delivery. Early diagnosis of these injuries is vital for the long-term planning of the management by the parents and medical team. Methods We describe a case of a term baby girl weighing 3300gms delivered at 39+4 weeks of gestation by forceps-assisted vaginal delivery following routine antenatal care. The baby was born floppy with no respiratory effort. She was admitted to the Neonatal Intensive Care Unit for therapeutic cooling with a provisional diagnosis of HIE. Following rewarming her neurological examination revealed severe hypotonia with no respiratory effort and remained invasively ventilated. MRI showed evidence of significant global insult and a hemorrhagic ischaemic brainstem injury. A follow-up MRI scan showed marked cervical cord atrophy with some residual foci of old hemorrhage. After review by the multidisciplinary team at our tertiary NICU, decision was that the baby had a very poor prognosis. she would not be able to maintain spontaneous respiratory function with only minimal voluntary movements of the limbs, if any, and a tracheostomy was not in her best interests. The parents and medical team agreed to the redirection of care. Results Spinal cord injury (SCI) is a rare and potentially underdiagnosed critical condition in the newborn, with an estimated incidence of 1 case per 29,000.¹ Diagnosing SCI in newborns is challenging due to the wide range of differential diagnoses and associated problems. Common initial misdiagnoses include hypoxic-ischemic encephalopathy, neuromuscular disorders, and sepsis. Spinal cord injury may masquerade as neonatal encephalopathy, and co-existing hypoxic-ischemic encephalopathy has been reported in up to 64% of affected infants. A high index of suspicion in cases of HIE presenting with atypical neurology followed by expert reporting of the MRI is vital for diagnosing spinal cord injuries.² Conclusion Birth-related spinal cord injury should be suspected and recognized to initiate the neuroprotective pathways and avoid further neural damage. MRI is a key diagnostic modality and should be performed to identify the injury and guide for further management. References Lee CC, Chou IJ, Chang YJ, Chiang MC. Unusual presentations of birth related cervical spinal cord injury. Front Pediatr 2020;8:514. Mills JF, Dargaville PA, Coleman LT, Rosenfeld JV, Ekert PG. Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging. J Pediatr 2001 Jan;138(1):105–8.