Pediatric/ BIRTH INJURIES

Avoidable and unavoidable mechanical and anoxic trauma affects the baby during labor.
The incidence is about 2-7 / 1000 live birth
predisposing factors includes macrosomia,prematurity, cephalopelvic disproportion,prolong labor and breach presentation.
5-8/100 000 infants die of traumatic birth injuries.
25/100 000 die because of anoxic injuries.
Some injuries may be latent initially but later result in severe sequele.

Cranial injuries

Caput succedaneum:
Is a diffuse sometimes ecchymotic edematous swelling of the soft tissues of the scalp involving the portion presenting during labor.
It may extent across the midline & across the suture lines.
The edema disappear during the 1st few days of life. No specific treatment is needed.

Caput succedaneum

Cephalhematoma:
is a subperiosteal hemorrhage , it is always
limited to the surface of one cranial bone
It does not cross the suture lines. No
discoloration of the overlying scalp.the
swelling starts after several hours after
birth. Occasionally an underlying
linear skull fracture is associated with
cephalhematoma.
It takes 2wks to 3 mo to be resorbed.
No treatment is needed but may be photo-
therapy to ameliorate hyperbilirubinemia.

cephalhematoma

A massive cephalhematoma may rarely
result in blood loss severe enough to
require transfusion.

Fractures of the skull :

linear skull fractures are the most common
cause no symptoms and requires no
treatment.
Depressed fractures by the use of forceps
delivery, it is advisable to elevate severe
compression to prevent cortical injury from
sustained pressure.

Subconjunctival and retinal hemorrhage are

frequent, petechiae of the skin of the head and
neck are common.


Peripheral Nerves InjuriesErb’s palsy: is an injury to C 5,6, there is failure of abduction of the arm from the shoulder unability for external rotationof the arm and to supinate the forearm.The characteristic position is adduction andinternal rotation of the arm and pronationof the forearm.The biceps reflex is absent. The Moro reflex is absent on the affected side.

Klumpks paralysis:

It is rare injury to C 7, 8 and T1. It produce
a paralyzed hand and ipsilateral ptosis and
meiosis if the sympathetic fibers of T1 are
injured.
Phrenic nerve paralysis:
C 3, 4, 5 injury result in dyspnea, cyanosis
and irregular breathing.

Facial nerve injury:

results from pressure over the facial nerve in
utero, from efforts during labor, or from
forceps during delivery,rarely it is due to
nuclear agenesis of facial nuclei.

When the infant cry:
there is movement only on the non paralized
side of the face, and the mouth is drawn to
that side.On the affected side the forehead
is smooth, the eye cannot be closed, the
nasolabial fold is absent.

Visceral Injuries

The liver is ruptured and there is formation
of subcapsular hematoma which may
tamponade furthur bleeding. The infant
appears normal in the initial 1-3 days non
specific signs related to loss of blood in
the hematoma may appear as poor feeding
irritability, pallor, jaundice, tacchypnea,
and tacchycardia. A mass may be palpable
in the right hypochondrium and abdomen
may appear blue, the hematoma may be
large enough to cause anemia.

Shock and death may occur if the hematoma

breaks into through the capsule into the
peritoneal cavity.

Rupture of the spleen may also occur alone
or in association with the liver.

Fractures:

Clavicles: usually results when there is
difficulty in the delivery of the shoulder in
vertex presentation and of the extended
arms in breach deliveries. The baby is
unable to move the arm freely on the affected side, bony irregularity may be palpated, occasionally discoloration may be visible over the fracture side. The Moro reflex is absent on the affected side.

Extremities: fracture of the humerus and
the femur. Spontaneous movement and
Moro reflex is absent on the affected
extremity.

Intracranial hemorrhage:

Intracranial hemorrhage may
result from:
1. Trauma and it is usually epidural
subdural or subarachnoid hemorrhage,
it occur when there is cephalopelvic
disproportion, prolonged labor, breach
delivery, or in mechanical intervention.

2. Asphyxia.

3. Thrombocytopenia.
4. DIC
5. Vit. K deficiency.
6. Other bleeding tendency or vascular
malformation,these results in
subarachnoid or intracerebral
hemorrhage.