Persistent Respiratory Failure Due to Low Cervical Cord Infarction in Newborn Babies

Perinatal infarction of the spinal cord is described in two premature babies who survived for several months. In both cases, there was bilateral, multisegmental infarction at the lower cervicothoracic arterial zone (inferior cervical sector), predominantly within the territory of the anterior spinal artery. Clinically, both infants had acute respiratory failure, diaphragmatic respiration, intercostal paralysis, bell-shaped deformity of the thorax, and bilateral arm paresis. Intubation and ventilator support were required for weeks. Eventual extubation was followed by recurrent respiratory failure, atelectasis, and pneumonia. At the level of the infarction, multiple, scattered scars were found in central, perimedullary, and intramedullary arteries, but not in their parent vessels. The etiology of the angiopathy was not determined. These cases demonstrate that discrete arterial infarction of the cord can occur in premature babies, and that such a lesion should be considered in the differential diagnosis of neonatal respiratory failure.