Birth injuries

for pediatrics UG teaching

1. Dr M.Sanjeevappa
M.D.(paeds)
Asst.Professor
Dept. of Paediatrics
GMC ,Ananthapuramu

2. An impairment of the infants body function
or structuredue to adverse influences that
occur at birth.

3. morbidity rate : 2.8 per 1,000 live births
mortality rate : 0.5 per 100,000 live births.

4. 1. Primiparity
2. Short stature
3. Maternal pelvic anomalies
4. Prolonged or unusually rapid labor
5. Oligohydramnios
6. Malpresentationof the fetus
7. Use of midforcepsor vacuum extraction
8. Versions and extraction
9. Very low birth weight or extreme prematurity
10. Fetal macrosomiaor large fetal head

5. Head and neck injuries.
Cranial nerve, spinal cord, and peripheral
nerve injuries.
Bone injuries.
Intra-abdominal Injuries.
Soft tissue injuries.

6. 1.Injuries associated with intrapartumfetal
monitoring.
2.Extracranialhaemorrhage.
3.Intracranial haemorrhage.
4.Skull fracture.
5.Facial or mandibularfractures.
6.Nasal injuries.
7.Ocular injuries.
8.Ear injuries.
9.Sternocleidomastoid(SCM) injury.
10.Pharyngeal injury

8. Oedema of the presenting part
caused by pressure during a
vaginal delivery
This is a serosanguineous,
subcutaneous, extraperiosteal
fluid collection with poorly
defined margins and
non fluctuating.

9. Subgalealhematoma is hemorrhageunder the
aponeurosisof the scalp.
The hemorrhagecan spread across the entire
calvarium.
presentation:
Pallor, poor tone, and a fluctuant swelling on the scalp.
Shock.
Ecchymosis of the scalp.
The mortality rate : 14% to 22%.
No specific therapy.
Hypovolemia –correction.
hyperbilirubinemia -phototherapy .
Infected hematoma –antibiotics.
Evaluate for bleeding disorders.

10. Subperiosteal collection of
blood between the skull and
the periosteum.
It may be unilateral or
bilateral, and appears within
hours of delivery as a soft,
fluctuant swelling on the side
of the head.
Never extends beyond the
edges of the bone or crosses
suture lines

13. Bleeding can occur
–External to the brain into the epidural,
subdural or subarachnoid space.
–In to the parenchyma of the cerebrum or
cerebellum.
–Into the ventricles from the subependymal
germinal matrix or choroid plexus.
Epidural hemorrhage.
Subdural hemorrhage.
Subarachnoid hemorrhage.
Intraparenchymalhaemorrhage.
Intraventricular haemorrhage.

15. SDH is due to rupture of the draining veins and
sinuses of the brain that occupy the subdural
space.
Clinical presentation :
Nuchalrigidity or opisthotonusposturing ,coma.
Apnea, abnormal respiratory patterns.
Unreactivepupils.
Abnormal extraocularmovements.
Bulging fontanelleand/or widely split sutures.
Seizures

16. Diagnosis :
MRI brain .
CT brain .
Neurosonogram.
LP contraindicated in large SDH.
Management :
Most infants with SDH do not require surgical
intervention.
Management of shock.
Management of seizures.
large SDH -Open surgical evacuation of the Clot.
Rule out sepsis or a bleeding diathesis.

17. A common form of ICH among newborns.
Source of bleeding is ruptured bridging veins of
SA space or ruptured small meningealvessels.
Clinical presentation :
Suspicion of SAH may result because of blood
loss or neurologic dysfunction.
Seizures, irritability, mild alteration of mental
status.

18. Diagnosis :
MRI brain
CT brain
Neurosonogram
LP
Management :
requires only symptomatic therapy.
Neurosurgical intervention.
hydrocephalus will develop after a moderate-
large SAH, thus follow-up neurosonograms
should be performed.

19. Primary cerebral haemorrhage is uncommon.
Secondary haemorrhage into a region of
hypoxic-ischemic brain injury.
In infants undergoing ECMO.
Intracerebellar haemorrhage occurs more
commonly in preterm infants.
MRI is the best imaging modality.

20. Management :
Acute management of IPH is similar to that for
SDH and SAH.
Long-term prognosis largely relates to location
and size of the IPH and GA of the infant.

21. IVH is found mainly in the preterm infant.
Incidence :15% to 20% in infants born at
<32weeks of GA.
IVH in the term infant is related to difficult
delivery or perinatal asphyxia.

23. COMPLICATIONS :
Periventricular hemorrhagic infarction (PVHI).
Posthemorrhagic ventricular dilation (PVD).

24. CLINICAL PRESENTATION :
Clinically silent syndrome.
Majority of IVH occur within 72 hours after birth.
The term newbomwith IVH presents with
seizures, apnea, irritability or lethargy, vomiting
with dehydration, or a full fontanelle.

25. MANAGEMENT :
Prevention of IVH should be the primary goal.
Premature newborn -supportive care.
Term newborn -supportive care and treatment
of seizures during the acute phase.
PVD -careful monitoring of ventricle size by
serial CUS and appropriate intervention when
needed to reduce CSF accumulation.

28. Macrosomia.
Shoulder dystocia.
Instrumented deliveries.
Malpresentation.

29. The most common.
Lack of shoulder movement.
The involved arm is held in the ‘‘waiter’s tip’’
position :
adduction and internal rotation of the shoulder.
extension of the elbow.
pronationof the forearm.
flexion of the wrist and fingers.
may be associated with injury tothephrenicnerve.

30. Biceps reflex is absent.
Moro reflex is absent.
Grasp reflex is present.

31. Rare.
Weakness of the intrinsic muscles of the hand;
and long flexors of the wrist and fingers.
Grasp reflex is absent.
Biceps reflex is present.
If cervical sympathetic fibersof the Th1 are
involved, Horner syndrome is present (ptosis,
miosis, and anhydrosis).

33. Physical examination.
Radiographs of the shoulder and upper arm.
Initial treatment is conservative.
The arm is immobilized across the upper
abdomen vselevated in abduction external
rotation of shoulder during the first week.

34. Physio therapy with passive range-of-motion
exercises at the shoulder, elbow and wrist
should begin after the first week.
Infants without recovery by 3 to 6 months of age
may be considered for surgical exploration.

35. The phrenicnerve arises from the third through
fifth cervical nerve roots.
Injury to the phrenicnerve leads to paralysis of
the ipsilateraldiaphragm.
Respiratory distress, with diminished breath
sounds on the affected side.

36. Chest radiographs show elevation of the
affected diaphragm, with mediastinalshift to
the contralateralside.
Ultrasonographyor fluoroscopy can confirm the
diagnosis by showing paradoxical
diaphragmatic movement during inspiration.

37. Initial treatment is supportive Oxygen.
Respiratory failure may be treated with
continuous positive airway pressure or
mechanical ventilation.
Gavagefeedings.
Plicationof the diaphragm

38. Symptoms :
Stridor.
Respiratory distress.
Hoarse cry.
Dysphagia.
Aspiration.
Diagnosis :
By direct
laryngoscopy

39. TREATMENT :
Small frequent feedings may be required to
decrease the risk of aspiration.
Intubation.
Tracheostomy.

41. Causes :
pressure on the facial nerves during birth.
by the use of forceps during birth.
Clinical features :
The affected side of the face droops and the
infant is unable to close the eye tightly on that
side.
When crying the mouth is pulled across to the
normal side.

42. Management :
protection of the
involved eye by
application of artificial
tears and taping to
prevent corneal injury.
neurosurgical repair of
the nerve should be
considered only after
lack of resolution
during 1 year of
observation

44. Clinical findings :
decreased or absent spontaneous movement.
absent deep tendon reflexes.
absent or periodic breathing.
lack of response to painful stimuli below the level of
the lesion.
Lesions above C4 are almost always associated with
apnea.
Lesions between C4 and T4 may have respiratory
distress.

45. Management :
If cord injury is suspected in the delivery room :
The head, neck, and spine should be
immobilized.
Therapy is supportive.

47. Clavicle is the most frequently injured bone in
the neonate during birth.
The infant may present with pseudoparalysis.
Examination may reveal crepitus, palpable
bony irregularity, and sternocleidomastoid
muscle spasm.
Desault'sbandage should be used for 7-10
days.

49. Tearing of the muscle fibersor fascialsheath with
hematoma formation and subsequent fibrosis.
Atrophic muscle fiberssurrounded by collagen and
fibroblasts.
The head is tilted toward the side of the lesion and
rotated to the contralateralside, chin is slightly
elevated.

50. Diagnosis :
physical examination.
Radiographs should be obtained to rule out
abnormalities of the cervical spine.
Ultrasonographymay be useful both
diagnostically and prognostically.
Treatment :
active and passive stretching
Surgery < 2years

51. Liver injury is the most common.
Three potential mechanisms
lead to intra abdominal injury:
(1) direct trauma.
(2) compression of the chest against the
surface of the spleen or liver.
(3) chest compression leading to tearing of the
ligamentaousinsertions of the liver or spleen

52. Clinical manifestations :
With hepatic or splenicrupture, patients
develop sudden pallor, hemorrhagic shock,
abdominal distention, and abdominal
discoloration.
Subcapsularhematomas may present more
insidiously, with anemia, poor feeding,
tachypnea, and tachycardia.

53. Diagnosis :
abdominal ultrasound.
Computed tomography.
Abdominal radiographs may show nonspecific
intraperitonealfluid or hepatomegaly.
Abdominal paracentesisis diagnostic ,if a
hemoperitoneumis present.

54. Treatment :
Volume replacement.
Correction of any coagulopathy.
Hemodynamically stable infant, conservative
management is indicated.
With rupture or hemodynamic instability, a
laparotomyis required to control the bleeding.