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Textbook  Kenner, C. (2016). Neonatal Nursing Care Handbook: An evidence-based approach to conditions and procedures. Springer Publishing Company

INCIDENCE Uncommon

PHYSIOLOGY/PATHOPHYSIOLOGY

  • Injury can occur at any point along the cord
  • Caused by excessive traction, rotation, and torsion of the vertebral column and neck
  • Occurs from stretching of spinal cord; damage ranges from complete transection to laceration, edema, hemorrhage, and hematoma formation (Bonifacio et al., 2012; Ditzenberger & Blackburn, 2014; Fenichel, 2007; Madsen, Frim, & Hansen, 2005; Volpe, 2008)

ASSESSMENT

  • Birth history: breech delivery, dystocia, macrosomia, cephalopelvic disproportion

CLINICAL MANIFESTATIONS/DIAGNOSIS

  • Spinal cord shock: hypotonia, weakness, flaccid extremities, sensory deficits, relaxed abdominal muscles, diaphragmatic breathing, Horner syndrome (ipsilateral ptosis, anhidrosis, and miosis), distended bladder
  • Low cervical lesions: shallow, paradoxical respirations
  • Degree of neurologic insult often cannot be accurately evaluated until the infant has recovered from the initial period of spinal shock and any edema or hemorrhage has been reabsorbed
  • Spinal ultrasonography, CT, or MRI to determine level and extent of injury

TREATMENT

  • Stabilize
  • Treat associated problems (e.g., asphyxia, hemorrhage, shock)
  • Maintain respiratory status
  • Midcervical to upper cervical or brainstem lesions require assisted ventilation
  • Monitor for signs of respiratory infection and pneumonia
  • Maintain skin integrity over the paralyzed area
  • Require meticulous bowel, bladder care; regular glycerin suppositories, urinary catheterization
  • Follow-up care: multidisciplinary team: nursing, medicine, neurology, neurosurgery, physical therapy, orthopedics, urology, social work, and psychology

PROGNOSIS

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  • Depends on the level and severity of the injury; generally, poor
  • Many are stillborn or die shortly after birth
  • Survivors have varying degrees of residual paralysis, respiratory problems, and bowel and bladder dysfunction, depending on the level of the injury