Birth spine and spinal cord injury (Draft of the clinical recommendations)

Birth spinal cord injury is damage to the spinal cord of a neonates due to mechanical causes during childbirth. The leading role in the development of spinal cord injury in newborns is played by excessive longitudinal or lateral traction of the spine or excessive twisting. The true incidence of birth spinal cord injury is unclear. There is currently no single classification of birth spinal cord injury and the distinction is made based on morphology, localization, nature and type of disorders. Birth spinal cord injury has 3 main groups of manifestations: stillbirth or rapid death of the newborn; respiratory failure; muscle weakness and hypotension, alternating with spasticity. Along with a visual examination of the newborn, it is recommended to conduct a study of the acid-base balance and blood gases in order to clarify the nature and treatment of respiratory failure; X-ray of the cervical and thoracic spine, ultrasound examination of the spinal cord, computed tomography of the spine and / or magnetic resonance imaging of the spine and spinal cord for the purpose of differential diagnosis; ultrasonic examination of the lungs to detect high placement of the diaphragm in case of damage to the C3–C5 segments of the spinal cord, consultations with a neurologist, anesthesiologist-resuscitator and a neurosurgeon. Mechanic respiratory ventilation is recommended for a newborn with birth spinal cord injury and with signs of damage to the C3–C5 segments and respiratory failure; in the presence of extramedullary damage, fracture or dislocation of the vertebrae — emergency neurosurgical treatment. Rehabilitation includes measures in the form of massage of the upper limb, therapeutic exercise, individual lessons, physiotherapy in order to restore the functions of the muscles and joints of the shoulder girdle; in case of respiratory regulation disorders — home ventilator systems; in case of persistent movement disorders after 1 month of age — transcutaneous electrical neurostimulation of the spinal cord. It is recommended to assess the size of the pregnant woman’s pelvis and the intrauterine presentation of the fetus in order to select the type of delivery to prevent birth spinal cord injury, rational drug therapy and anesthetic care for the pregnant woman in order to prevent dysfunctional labor.