Delayed Cancer Diagnoses Leaves Infant Permanently Paralyzed

Pediatric Expert

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.

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

Expert-ID: 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.

Expert Witness Response E-177337

I am an assistant professor and pediatric hematologist-oncologist. I am board certified in pediatrics and I have been practicing in an academic institution since 2015. At 7 months of age, a baby should be moving both legs equally and spontaneously. The baby should also be able to bear weight with support. If a parent brings in an infant with decreased movement in their extremities, I would perform an extensive neurologic exam, including neurology consultation, and obtain imaging of the affected joint plus spine. I tend not to rely on the nurse’s clinical documentation but rather on my own physical exam and assessment. I have treated a patient for neuroblastoma with a similar presentation. Imaging was obtained upon presentation to our emergency room, treatment was initiated, and the patient is now neurologically normal.


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