Latent Spinal Cord and Brain Stem Injury in Newborn Infants

作者：Abraham Towbin · 发表于：Developmental Medicine & Child Neurology · 年份：1969 · DOI：10.1111/j.1469-8749.1969.tb01395.x · 被引用次数：79 · 研究领域：Neonatal and fetal brain pathology、Neuroscience of respiration and sleep、Neonatal Respiratory Health Research

SUMMARY Spinal cord and brain stem injuries occur often during the process of birth, but frequently escape diagnosis. Respiratory depression in the neonate is a cardinal signal of such injury. In infants who survive there may be lasting neurologic defects reflecting the primary injury; in some, secondary hypoxic damage to the cerebrum may ultimately be manifested as cerebral palsy, mental retardation, or other central nervous system defects. A broad range of lesions occur, due to stretch‐injury or to compression of the substance of the cord and brain stem. Laceration and hemorrhage of the cord and brain stem occur. The spinal and cranial nerve roots may be damaged, as well as dura and neighboring structures; spinal epidural hemorrhage is common. On the basis of the present investigation and past clinical and pathologic studies it is believed that brain stem and spinal injuries at birth are essentially attributable to excessive longitudinal traction, especially when this force is combined with flexion and torsion of the spinal axis during delivery. Contributing factors include prematurity, primiparity, intrauterine malposition of the fetus, dystocia and precipitous delivery. The occurrence of spinal cord or brain stem injury in 10 to 33 per cent of neonatal deaths autopsied, reported in the past and reflected in the present study, indicates the significance of this form of birth trauma–and the need for wider consideration of this form of nervous system damage and its sequelae ...