Spinal Cord Injury – Systems Affected
There are different things that can result in spinal cord injury to babies during birth. Stressful deliveries could result in damage to the spine due to traction on the newborn’s trunk during a breech delivery, hyperextension of the head in an abnormal birthing position and even rotational stressed applies to the spine’s axis. Unfortunately, this kind of birth injury can result in permanent damage such as paralysis and long-term brain damage.
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When an injury occurs to the spine, the spine swells at the damaged area and cuts off critical blood supply to nerve tissue, denying the injured area oxygen. This then sets off a waterfall-effect of devastation that can affect the entire body, resulting in the injured spinal tissue dying off, being stripped of insulation, and damaged even further by a negative response of the immune system.
While it is scary to think of your baby having life-long damages, it is important to understand what effect such an injury has on the system, including:
- Flood of neurotransmitters – the injury can lead to an excessive release of neurotransmitters in the system. These biochemicals that allow nerve cells to communicate, overexcite the cells, leading to them dying off, and killing off nerve cells that surround and protect the spine and that usually allow for information to be transmitted to and from the brain.
- Blood flow – blood flow at the injury site becomes sluggish and reduces the flow to nearby areas, soon affecting the entire body. The body then loses the ability to self-regulate which can lead to severe drops in heart rate and blood pressure.
- Free radicals – the inflammation caused by cells in the baby’s immune system unleash an onslaught of free radicals that react destructively, damaging healthy nerve cells.
- Invasion of immune cells – cells of the immune system speed over to the damaged part of the spine, promoting inflammation. The cells stimulate the release of cytokines which are toxic to nerve cells.
- Self-destruction of nerve cells – the natural process of programmed cell death becomes uncontrollable at the site of injury, reducing the integrity of the infant’s spinal cord.
Furthermore, additional damage tends to occur over the days and weeks following the injury due to inflammation, swelling, bleeding, and the buildup of fluid around the spine.
Symptoms to Be Aware Of
After a distressing birth injury, babies may have varying degrees of symptoms connected with the severity and site of the injury. The site of the spinal injury will determine just how severe the injury is. For instance, an injury that damages the neck area may lead to the loss of muscle function or strength in the arms and legs, leading to long-term paralysis. This kind of injury usually necessitates medical breathing assistance, like a ventilator, since the chest muscles may also be weakened from the injury.
The extent of the damage to the spine will determine whether the injury is incomplete or complete. An incomplete injury means there is still a degree of feeling and movement below the area of the injury. However, a complete injury means that the baby will have no feeling or movement below the site of the injury.
The true incidence of such injuries can be difficult to determine. The major sites of this kind of injury during birth include:
- Lower cervical region
- Upper thoracic region for breech delivery
- Mid-cervical and upper cervical region for vertex delivery
Major neuropathologic changes usually consist of acute lesions, or hemorrhages, which are associated with different degrees of laceration, stretching, and total transaction. In such cases, the baby is usually stillborn or dies shortly after birth after failing to establish sufficient respiratory function.
Infants who survive often experience hypotonia and weakness, as well as neuromuscular disorders. Later, many infants develop spasticity that can be mistaken for cerebral palsy.
The Outlook
Diagnosis is typically made using a CT or MRI scan, and supportive therapy can then be determined. The most important aspect of the baby’s medical care is prevention. The obstetric management of breech deliveries along with pharmacologic augmentation of labor and instrumental deliveries all need to be appropriate to prevent the birth trauma as best possible.