Assuntos
Traumatismos do Nascimento , Doenças do Sistema Nervoso Periférico , Paralisia Respiratória , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/inervação , Humanos , Paralisia , Nervo Frênico/lesões , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologiaRESUMO
PURPOSE: To describe the clinical signs of Descemet membrane (DM) detachment due to forceps-related birth injury and its subsequent management using optical coherence tomography. METHODS: Case report. RESULTS: A 3-day-old term infant presented with left eye corneal clouding and a definitive history of traumatic forceps-assisted delivery. Despite topical therapy, corneal clouding persisted, necessitating an examination under anesthesia using ultrasound and handheld optical coherence tomography. This revealed not only a tear in DM but also a large detachment. Injection of air alone failed to achieve apposition of DM to the posterior stroma. Apposition was achieved only after penetration of the overlying cornea with the needle of a 10-0 nylon suture and release of clear viscous fluid. The cornea cleared within the first week and continued in the months to follow. CONCLUSIONS: Prolonged corneal edema should alert the physician to probable DM detachment after forceps-related birth injury. Injecting air alone may not be sufficient to reattach the detached DM.
Assuntos
Traumatismos do Nascimento/cirurgia , Edema da Córnea/cirurgia , Opacidade da Córnea/cirurgia , Lâmina Limitante Posterior/lesões , Traumatismos Oculares/cirurgia , Forceps Obstétrico/efeitos adversos , Traumatismos do Nascimento/diagnóstico por imagem , Traumatismos do Nascimento/etiologia , Edema da Córnea/diagnóstico por imagem , Edema da Córnea/etiologia , Opacidade da Córnea/diagnóstico por imagem , Opacidade da Córnea/etiologia , Lâmina Limitante Posterior/diagnóstico por imagem , Traumatismos Oculares/diagnóstico por imagem , Traumatismos Oculares/etiologia , Seguimentos , Humanos , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Oftalmológicos , Tomografia de Coerência ÓpticaRESUMO
OBJECTIVES: To establish criteria, evident soon after birth, that predict long-term outcome of neonates with spinal cord injury (SCI) at birth. DESIGN: Retrospective case-series. SETTING: Five Canadian regional neonatal tertiary care centers. PATIENTS: Consecutive samples of patients referred to five centers for a total of 22 subjects, in whom SCI was diagnosed during life. Sites of lesions were above the fourth cervical vertebrae (n = 14), at the fourth cervical to the fourth thoracic vertebrae (n = 6), and at the thoracolumbar region (n = 2). MEASUREMENTS AND MAIN RESULTS: All 14 patients with upper cervical SCI had cephalic presentations, whereas all 6 patients with cervicothoracic SCI had breech presentations (p < 0.0001). The site and extent of lesion were best diagnosed by clinico-imaging correlations. Ultrasonography appeared to be the most useful imaging study. In patients with upper cervical SCI who had no coexistent central nervous system abnormality associated with early death, long-term outcome in survivors (dependency on mechanical ventilation and on aids for upper limb activity and for ambulation) was best predicted by age when breathing was first observed and by rate of recovery of limb motor function in the first 3 months. The presence of breathing movements on day 1 (n = 2) was associated with mild disability. The absence of breathing movements on day 1 and little or no recovery of motor function in the first 3 months was associated with permanent total dependency on mechanical ventilation and severe quadriplegia (n = 5). Apnea on day 1 and intermediate recovery rates in the first 3 months was associated with variable long-term prognoses (n = 3).