Brief Literature Review: Called to Accidental Decapitation?
Phillip V. Gordon MD, PhD1, and Jonathan R. Swanson MD2
1Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA
2Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
e-Journal of Neonatology Research
Author Disclosure: The authors have nothing to disclose.
Neonatologists are pessimists by nature. Most of us started our careers as adrenalin junkies, feeding off the stress and uncertainty of the NICU. Even today, fellows can be found in the NICU once or twice month, sitting in the fishbowl late in the evening and wondering what is the worst thing that could possibly happen next.
The reality is there are some events that are the equivalent of the Kobayashi Maru (the fictional scenario in Star Trek for which there were no good solutions). The ones that come to mind include tracheal agenesis or florid hydrops from congentially acquired herpes or congenital hepatic hemangioma. These are terrifying realities from which an alive infant is unlikely to emerge (and an intact one would need to walk on water). But there is an even more frightening nightmare, one that we doubt has ever actually happened, but that many of us have heard urban legends about late at night as we sat in that fish bowl. It is the call of the neonatal team to the delivery room with the concurrent accidental decapitation of a macrosomic infant because of vigorous extraction during shoulder dystocia (to overcome vaginal entrapment).
METHODS / RESULTS
We wondered how often does accidental decapitation actually happen and thus what is the likelihood of such a grotesque scenario actually ever impacting the neonatal resusciation team. To approach this question in a semiquantitative manner, we did the following literature searches:
Google: newborn and decapitation (>15 pages), decapitation at birth (> 15 pages) – both searches yielded three cases (one from Missouri in 2006, one from Kentucky in 2006 and one from Brazil in 2012, with all other hits being reports of the same cases).1-3
PubMed: newborn and decapitation (94 hits, one case in 2010 from Isreal),4 decapitation at birth (47 hits, 0 cases).
We found four examples of accidental newborn decapitation in the electronic media using a limited search from 2006 – 2012. During the same period there were approximately 131 million newborns worldwide per year (788.4 million over six years).5 If four were an accurate number, the incidence of accidental decapitation would be 1/197.1 million. Assuming that this horrendous outcome is somewhat under-reported (perhaps by a factor of five or more) in order to protect the reputations of institutions and their physicians, we think it reasonable to estimate that the incidence of accidental decapitation worldwide may be as rare as 1/39 million live births.
The chance that a neonatal team will be called to an accidental decapitation is remote and is unlikely to occur in one’s neonatal career.
- Nelson SC. Arteisha Betts and Travis Ammonette sue doctors for ‘attempting to conceal decapitation of baby at birth.’ The Huffington Post United Kingdom. 16 October 2012. Retreived from: http://www.huffingtonpost.co.uk/2012/10/16/arteisha-betts-and-travis-ammonette-sue-doctors-for-attempting-to-conceal-decapitation-of-baby-at-birth_n_1969793.html.
- Riley J. Louisville jury to decide case of baby decapitated during birth. The Courier-Journal. 4 October 2011. Retrieved from http://www.courier-journal.com/article/20111004/NEWS01/310040093/Louisville-jury-decide-case-baby-decapitated-during-birth.
- Nelson SC. Baby decapitated at birth: horror in Brazilian hospital. The Huffington Post United Kingdom. 21 May 2012. Retrieved from: http://www.huffingtonpost.co.uk/2012/05/21/baby-decapitated-at-birth-horror-in-brazilian-hospital_n_1532327.html.
- Hiss J, Kahana T, Burshtein I. Accidental Fetal Decapitation: A Case of Medical and Ethical Mishap. Am J Forensic Med Pathol 2011; 32(3):245-7.
- Ecology Global Network. World Birth and Death Rates. Retrieved from www.ecology.com/birth-death-rates.