PMC2092440_01
Photograph of the newborn, showing the extensive MMC, extending from +/- the 4th thoracic vertebra till the midlumbar region
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Fig1
Physical examination revealed a huge MMC at high thoracic level (Fig. 1), a very large head with a large but soft fontanel, a marked deformation of the thorax with scoliosis, and clubfeet.
Photograph at the end of the surgical procedure. The MMC was closed by making use of extensive rotational flaps together with free skin grafting
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Fig2
The MMC team decided to respect the parents will and on day 3 the back lesion was closed by the neurosurgeon in collaboration with the plastic surgeon, making use of extensive rotational flaps together with free skin grafting (Fig. 2).
a Comfort scores during the first month of life (min = 5: no discomfort; max = 35: extreme discomfort). Green bars: only paracetamol (intermittently) being used. Green/black bars: low-dose morphine together with paracetamol being used. b The same as a, but now with the VAS (min = 0: no pain; max = 10: most severe pain) Note: The combination of a Comfort score of at least 17 and a VAS of at least 4 indicates that the well-being of the newborn is in jeopardy. In such a situation, the attending nurse is expected to determine the cause of the discomfort and to take adequate measures (changing a full nappy, feeding a hungry child, emptying a full bladder, giving adequate painkillers if appropriate, etc.) to secure the child's well-being
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Fig3
The same child at 7 months old; fixating and following with the eyes, vocalizing, normal movements of the arms, moving both legs vigorously (perhaps nonvoluntary), still being partially fed by a nasogastric tube
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Fig4
In summary, this case not only demonstrates that there is no such thing as 'suffering' in these newborns, but also the incorrectness of the statement of Verhagen et al. (2005a) that "the suffering of these newborns cannot be alleviated by any means in a proper medical way" (Fig. 4).
a and b Preliminary results of the Rotterdam Prospective Study on Discomfort in Newborns with MMC (n = 13)
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Fig5