Yokoi K, Kobayashi S, Muramatsu K, Suzuki S, Gotou H
J Neonatal Perinatal Med. 2017;10(2):195-198. doi: 10.3233/NPM-171695.
Neonatal spinal cord injury is an extremely rare perinatal complication that often occurs concurrently with hypoxic ischemic encephalopathy (HIE), further complicating diagnosis of spinal cord injury. Although therapeutic hypothermia for moderate to severe HIE is widely recommended in Japan, it is difficult to determine whether it satisfies the neurological findings-related entry criteria in some patients.We describe a female infant with neonatal spinal cord injury after forceps delivery, who underwent therapeutic hypothermia upon diagnosis of HIE. The Apgar scores were 5 at 1 min, 6 at 5 min, and not recorded at 10 min. Blood gas analysis of her umbilical artery was not performed. Since respiratory failure, hypotonia and the absence of primitive reflexes were found at 2 hours after birth, she was initially diagnosed with moderate HIE and underwent a therapeutic hypothermia. Magnetic resonance imaging after therapeutic hypothermia revealed the spinal cord was narrowed from the lower medulla oblongata to the upper cervical cord. Thus she was diagnosed with an upper spinal cord injury at that time.Some patients with neonatal spinal cord injuries satisfy the criteria for therapeutic hypothermia. When neonates with asphyxia present with prolonged respiratory failure and hypotonia, spinal cord injury should be considered in the differential diagnosis. Thus, an early MRI is vital for the diagnosis of spinal cord injury.
新生儿脊髓损伤是一种极其罕见的围产期并发症，常与缺氧缺血性脑病（HIE）同时发生，这进一步使脊髓损伤的诊断复杂化。尽管在日本广泛推荐对中重度HIE进行治疗性低温，但在某些患者中很难确定其是否满足与神经学检查结果相关的纳入标准。我们描述了一名在产钳助产术后发生新生儿脊髓损伤的女婴，她在被诊断为HIE后接受了治疗性低温治疗。其阿氏评分在1分钟时为5分，5分钟时为6分，10分钟时未记录。未对其脐动脉进行血气分析。由于出生后2小时发现呼吸衰竭、肌张力低下且无原始反射，她最初被诊断为中度HIE并接受了治疗性低温治疗。治疗性低温治疗后的磁共振成像显示脊髓从延髓下部到颈髓上部变窄。因此，她当时被诊断为上脊髓损伤。一些新生儿脊髓损伤患者符合治疗性低温的标准。当窒息新生儿出现长时间呼吸衰竭和肌张力低下时，鉴别诊断中应考虑脊髓损伤。因此，早期磁共振成像对脊髓损伤的诊断至关重要。
