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Birth Trauma IN Newborns: DR Vanessa Lee Wan Mun Paediatrician Hospital Melaka 23 OCTOBER 2018
Birth Trauma IN Newborns: DR Vanessa Lee Wan Mun Paediatrician Hospital Melaka 23 OCTOBER 2018
TRAUMA
IN
NEWBORNS
SOFT TISSUE
1. Cephalohematoma BONE
2. Subaponeurotic 1. Clavicle
VISCERAL
hematoma 2. Long bone
1. Hepatic rupture
3. Caput succedaneum 3. Epiphyseal
2. Splenic rupture
4. Subconjunctival displacement
hemorrhage
5. Laceration/abrasion
6. Subcutaneous fat NERVE
necrosis 1. Brachial plexus
2. Facial nerve INTRACRANIAL
3. Laryngeal nerve 1. Subarachnoid
4. Phrenic 2. Epidural
nerve/diaphragmatic 3. Subdural
paralysis
5. Spinal cord
Introduction
• Definition : Injuries that occur during birth
process
• Incidence : 2 to 7 per 1000 live births
• Risk factors :
– Fetal factors LBW, macrosomia,anomalies,
prematurity, abnormal presentation
– Maternal factors CPD, small stature, pelvic
abnormalities, oligohydramnios,
– Prolonged labour, Instrumental deliveries
SOFT TISSUE INJURY
SCALP SWELLINGS
SOFT TISSUE INJURY
CEPHALOHEMATOMA
• Bleeding below periosteum
• Confined within margins of
skull suture
• Increased risk with vacuum
metal cup
• Resolution within weeks
• Complications : jaundice,
calcification of hematoma
MANAGEMENT :
Reassurance, monitoring of
COH
SOFT TISSUE INJURY
CAPUT SUCCEDANEUM
• Subcutaneous fluid
collection
• Extraperiosteal; poorly
defined margins, cross
sutures
• Associated with molding
• Resolves within days
MANAGEMENT : Reassurance;
observation
SOFT TISSUE INJURY
SUBAPONEUROTIC
HEMATOMA
• bleeding in the potential
space between periosteum
and the scalp galea
aponeurosis
• fluctuant, boggy mass
developing over the scalp
• Crossing suture lines
• Usually 12-72 hours
• HEMORRHAGIC SHOCK!
MANAGEMENT :
vigilant monitoring (hourly)
Blood transfusion
Phototherapy
SUBCONJUNCTIVAL HEMORRHAGE
• Benign condition
• Risk factors: prolonged
labour; excessive force
during delivery; big
baby; cord round neck
• Resolves spontaneously
over 2-4 weeks
SOFT TISSUE INJURY
ABRASION/LACERATION
MANAGEMENT
1. KEEP CLEAN AND DRY
2. WATCH FOR INFECTION
BONE INJURY
• Unpredictable, unpreventable
CLAVICLE FRACTURE complication
• Incidence : 0.2 – 3.5%
• Risk Factors
– shoulder dystocia
– birth weight
– midforceps delivery /vacuum
*Can occur in NORMAL
DELIVERY; NORMAL NEWBORNS
• Clinical exam
– Crepitus
– Deformity
– Pseudoparalysis
• Heals within 7-10 days; good
prognosis
• Tx : reduce pain immobilization
NERVE INJURY
1. Brachial plexus
2. Facial nerve
3. Laryngeal nerve
4. Phrenic nerve/diaphragmatic paralysis
5. Spinal cord
BRACHIAL PLEXUS INJURY
• Incidence 0.5-2 per 1000 Four fold rise with
live births shoulder dystocia
• Large babies, shoulder
dystocia, breech delivery
• Associated with:
– fractured clavicle
– fractured humerus
– subluxation of cervical
spine
– cervical cord injury
– facial nerve palsy
BRACHIAL PLEXUS INJURY
1. Hepatic Rupture
2. Splenic Rupture
VISCERAL INJURY
• Uncommon
• Fulminant or insidious
• Hemorrhage most serious complication
– Leading to hypovolaemic shock
– Suspect in infant with shock, pallor, unexplained
anemia, abd distention
INTRACRANIAL INJURY
1. Subarachnoid
2. Intraparenchymal
3. Subdural
4. Intraventricular
INTRACRANIAL BLEED
• Pathophysiology varies depending on types
• Risk factors : traumatic birth; hypoxic ischemic
injury (HIE)
• Complications : hypovolaemia, anemia, seizures
• Diagnosis :USG brain CT scan