Birth Injury

Question 1

How is birth injury defined?

Answer 1

Birth injury is defined as an impairment of the newborn infant’s body function or structure due to a traumatic event that occurred at birth.

Question 2

When can birth injuries occur?

Answer 2

Birth injuries may occur during labor, delivery, or after delivery, especially in newborn infants who require resuscitation in the delivery room.

Question 3

What factors increase the risk of birth injuries related to the fetus?

Answer 3

Factors related to the fetus include fetal size and presentation.

Question 4

What factors increase the risk of birth injuries related to the mother?

Answer 4

Factors related to the mother include maternal size and the presence of pelvic anomalies.

Question 5

What factors increase the risk of birth injuries related to delivery?

Answer 5

Excess force used, such as in impacted shoulders, or the use of obstetrical instrumentation during delivery, such as vacuum and forceps deliveries.

Question 6

What are some superficial head injuries commonly seen in newborns?

Answer 6

Abrasions,
lacerations, and
bruises from forceps, vacuum cup, or scalp clip lesions.

Question 7

How are superficial head injuries typically managed?

Answer 7

They are generally self-limited and resolve without intervention. Some lacerations, especially with Caesarean deliveries, may require repair with sterile strips

Question 8

What is caput succedaneum, and how does it differ from cephalohematoma?

Answer 8

Caput succedaneum is an edematous swelling of the scalp above the periosteum, occurring after prolonged engagement of the fetal head in the birth canal or after vacuum extraction. Unlike cephalohematoma, it extends across the suture lines

Question 9

What is cephalohematoma?

Answer 9

Cephalohematoma is a subperiosteal collection of blood caused by rupture of vessels beneath the periosteum, usually over the parietal or occipital bone, presenting as swelling that does not cross suture lines.

Question 10

How is cephalohematoma managed?

Answer 10

No treatment is indicated as it is usually reabsorbed within 3 months. However, it may cause jaundice.

Question 11

What is a subaponeurotic (subgaleal) hemorrhage?

Answer 11

It develops when blood accumulates in the loose tissue between the periosteum of the skull and the aponeurosis.

Question 12

How does a subaponeurotic hemorrhage occur?

Answer 12

The injury occurs when the veins between the scalp and dural sinuses are sheared or severed due to traction on the scalp during delivery.

Question 13

What is the potential risk associated with a subaponeurotic hemorrhage?

Answer 13

There is a potential for massive blood loss, amounting to 20 to 40 percent of a newborn infant’s blood volume, into the subaponeurotic space, contributing to a high mortality rate.

Question 14

What kind of condition is a subaponeurotic hemorrhage?

Answer 14

It is a potentially lethal condition that requires early diagnosis, close monitoring, and aggressive management.

Question 15

What are the types of skull fractures?

Answer 15

Linear or depressed.

Question 16

What causes depressed skull fractures?

Answer 16

Depressed skull fractures are due to direct pressure to the skull, often from forceps delivery or the mother’s pelvis.

Question 17

What is the typical presentation of depressed skull fractures?

Answer 17

They are usually asymptomatic, though occasionally associated with brain injury.

Question 18

What action is needed in cases of depressed skull fractures?

Answer 18

Urgent neurosurgical consultation is needed.

Question 19

What are the types of intracranial hemorrhages (ICH) as a consequence of birth injury?

Answer 19

They include subdural, subarachnoid, and intraventricular hemorrhages, and less frequently, intracerebral and intracerebellar hemorrhages.

Question 20

What causes periventricular hemorrhage, and how does it differ from other intracranial hemorrhages?

Answer 20

Periventricular hemorrhage is due to hypoxia rather than trauma, distinguishing it from other types of intracranial hemorrhages.

Question 21

What are the clinical features associated with intracranial hemorrhages in newborns?

Answer 21

Clinical features may include a full fontanelle, splayed sutures, marked drop in packed cell volume (PCV), irritability, hypotonia with poor suck, hypertonia, vomiting, apnea, and convulsions.

Question 22

What is a subconjunctival hemorrhage, and how long does it typically take to resolve?

Answer 22

A subconjunctival hemorrhage is absorbed within 10 days.

Question 23

Management of head injuries

Answer 23

• Resuscitate if needed.
• May require blood and fresh frozen plasma.
• Nurse in incubator, feed with nasogastric tube if necessary and monitor.
• Depressed fractures should be elevated surgically.
• Subdural haematoma may need to be drained surgically

Question 24

Types of head injuries

Answer 24

1. subconjunctival hemorrhage
   2.intracranial bleeding
2. skull fracture
3. sub aponeurotic (subaleal) hemorrhage
4. celphalhaematoma
5. caput succedaneum
6. superficial

Question 25

types of nerve injuries

Answer 25

1. brachial plexus 2. facial nerve palsy

Question 26

What is Erb’s palsy?

Answer 26

Erb’s palsy is characterized by the arm being extended and pronated. Initially, the arm is flaccid and may present as an asymmetrical Moro reflex. It may recover fully.

Question 27

When should referral for surgery be considered in cases of Erb’s palsy?

Answer 27

Referral for surgery should be considered if there is no improvement by 1 month.

Question 28

What causes facial nerve palsy in newborns?

Answer 28

Facial nerve palsy may result from pressure by a prominent maternal sacral promontory or secondary to forceps delivery.

Question 29

How is facial nerve palsy manifested?

Answer 29

Weakness of the upper and lower face is accentuated during crying, where the mouth is drawn over to the unaffected side. Spontaneous recovery within 2 weeks is usual.

Question 30

What are the characteristics of a clavicle fracture in newborns?

Answer 30

Clavicle fractures typically occur mid-clavicularly and are often missed as they cause few signs. However, they heal spontaneously.

Question 31

What signs may indicate a humerus or femur fracture in newborns?

Answer 31

Bruising, swelling, immobility, and crepitus may indicate humerus or femur fractures. These fractures may follow a difficult delivery of a breech or impacted shoulders

Question 32

What is a common associated finding in infants with humeral fractures?

Answer 32

Brachial plexus injury is a common associated finding in infants with humeral fractures.

Question 33

How should a humerus fracture be immobilized to reduce pain?

Answer 33

The humerus should be immobilized by strapping the arm to the side to reduce pain.

Question 34

What is the typical treatment for neonatal femoral fractures?

Answer 34

The Pavlik harness is generally used to treat neonatal femoral fractures, in consultation with orthopedic surgeons. Analgesia may be needed.

Question 35

What are common causes of bruising in newborns?

Answer 35

Bruising is common after a difficult delivery, especially breech, and in preterm infants.

Question 36

How might a tight cord around the neck cause bruising?

Answer 36

A tight cord around the neck may cause facial bruising with petechiae due to capillary rupture.

Question 37

How can bruising lead to jaundice in newborns?

Answer 37

Bruising can result in jaundice due to the breakdown of extravascular blood.

Question 38

What abdominal injury may occur following a traumatic breech delivery with traction on the abdomen?

Answer 38

Rupture of the liver.