BIRTH INJURIES

nDefinition An impairment of the infant’s body or structure due to adverse influences, which occurred at birth.

Risk factors 1

Primiparity

Small maternal stature

Prolonged or rapid labour

Oligohydramnios

Malpresentation

  • Assisted delivery
  • Macrosomia or large head
  • Fetal anomalies.
  • Pelvic anomalies
  • Cephalhematoma:subperiosteal haemorrhage,common site is the parietal bones,rarely the occiput.it is limited by the suture line.It may cause anemia and jaundice.Linear skull fractures may underlie a cephalhematoma(5-20%).
  • Resolution occurs over weeks ending with calcification.
  • NO TREATMENT
  • Aspiration should never be done
  • CT scan if N.manifestations.
  • Subgaleal hematoma
  • Hemorrhage under the aponeurosis of the scalp

Hematoma may cause shock

  • Mortality 20%

Investigate for bleeding disorders.

  • Not limited by suture lines
  • Erbs palsy: It involves C5,C6 nerve roots, the limb is held limply on the side of the body. With forearm pronated (waiter” tip position). Grasp reflex is present.Recovery>80%

Physical therapy should start by 7-10 days.

  • Chignon:edematous part of the scalp when a vacum extractor is used.

Facial nerve injury

The most common N. injury.

Incidence 1.8-7.5/1000 live birth

Etiology:Compression by sacral promontory,forceps,masses

Central

Peripheral N.branch injury

Recovery by 3 weeks.Good prognosis

DD:Con.abscence of Depressor Anguli Oris Muscle,cong. Absence of Facial ms.

Klumpkes;paralysis:C7-8,T1 are involved, the small muscles of the hand and wrist are affected, loss of sweating and sensation may also be seen.

Grasp reflex is absent.

Bad prognosis

 Fracture of the clavicle

Most common bone injury

Asymptomatic or features of pseudoparalysis

A callus at 7-10 days.

Treatment:Analgesics,Pinn the sleeve to the bed of the infant.

Complete recovery is expected.

Sternocleidomastoid tumor

1-2 cm mass

Appears at 2-3 weeks.

Usually unilateral

Recovery in 80% in 3-4 months by physiotherapy.

Plastic Surgery is needed if lesion persists for 6 months.

-Caput succidinum

Subcut.collection of fluid

Poorly defined margins

Crosses the midline and sutures.

Resolves spontaneously.

Ruptured organs

1-ruptured liver.

2-ruptured spleen.

3-adrenal hemorrhage.common in infants of diabetic mothers.

all are seen due to pressure on these organs during delivery,commonly in breech presentation.

Contributing factors:large infants,perinatal asphyxia,coagulation disorders,extreme prematurity.

Shock.

Abdominal mass.

Cyanosis.

Treatment:supportive,surgical repair,treatment of adrenal failure.

Other injuries

Linear skull fractures.

Subcojunctival hemorrhages&Retinal hemorrhages.

Fractures of long bones.

Significant birth injuries accounts for <2% of causes of death in neonates.

Larger infants are more liable.

Most birth traumas are self-limited.50% are avoidable.