This case involves a 7-month-old male patient whose right leg was not moving with the same range of motion as the left. He was admitted for a workup, but X-rays and a skeletal survey came back negative. Although the nurse noted that the infant wasn’t moving his right leg with the appropriate intensity or range of motion, the infant was discharged without a diagnosis. The infant continued to experience issues moving his leg for 3 months before he was eventually referred for further investigation. Additional testing diagnosed the infant with a paraspinal tumor which was found to be a neuroblastoma. Because the tumor had compromised the infant’s nervous supply to the legs, he was rendered permanently paralyzed. An expert in pediatric care was sought to opine on whether there was a lapse in the standard of care for this infant.
Delayed Cancer Diagnoses Leaves Infant Permanently Paralyzed
Question(s) For Expert Witness
- 1. At 7-months of age, what is considered normal regarding the movement of lower extremities?
- 2. What should be the workup when an infant presents with decreased movement in their extremities?
- 3. How important are the nurse's notes for decision-making on a hospitalized patient?
Expert Witness Response E-014119
I have 30+ years of experience caring for children and adolescents with spinal cord injuries, including those due to neuroblastomas. I currently spend about 70% of my time in academia and administration, and the other 30% I spend in clinical or consulting practice. At 7 months of age, a baby should have symmetric legs movements. The nurses and parents would be an important source of documenting such an abnormality. A thorough physical evaluation and radiographs of the legs, in addition to an MRI and CT of the abdomen and spine, should be performed.
Expert Bio:
This highly qualified expert is board certified in pediatrics with a subspecialty in spinal cord injury medicine. This expert completed an internship and residency in pediatrics at a prestigious university and formerly served as the president of a spinal injury association and various pediatric societies. This expert has authored over 135 peer-reviewed journal articles and 22 book chapters. This expert currently serves as the chief of pediatrics at a prominent midwestern children’s hospital and is also a professor of pediatrics at a major medical school.