2. INTRODUCTION
• A wide variety of disorders affecting the newborn may
originate in utero, during birth or in immediate post natal
period.
• These disorders may be due to prematurity, genetic
mutations, chromosomal aberrations or acquired from
environment
3. Birth Injuries
• The term birth injury is used to
denote: avoidable and unavoidable
mechanical, hypoxic ischemic injury
affecting the infant during labor and
delivery
• 0.7% (Seven of every 1,000) births
result in birth injuries. Though most
women give birth in modern hospitals
surrounded by medical professionals.
• Birth injuries account for fewer than
2% of neonatal deaths.
4. predisposing factors
• Primiparity
• maternal short stature
• Maternal pelvic anomalies
• Prolonged or unusually rapid labor
• Oligohydramnios
• Malpresentation of the fetus (breech)
• Cephalopelvic disproportion
• Deep transverse arrest of presenting part
of the fetus
5. Cont……
• Use of forceps or vaccum extraction
• Versions and extractions
• Very low birth weight or extreme prematurity
• Fetal macrosomia birth weight over about 4,000
grams
• Fetal macrocephaly (Large head)
• Fetus anomalies
8. Abrasions and lacerations
• May occur as scalpel cuts during
Cesarean delivery or during instrumental
delivery (i.e, vacuum, forceps)
• Infection remains a risk, but most
uneventfully heal
Management
• Careful cleaning, application of antibiotic
ointment, and observation
• Lacerations occasionally require suturing
10. Caput succedaneum
• A caput succedaneum is an
edema of the scalp caused by a
bleed below the scalp and above
the periosteum and involves a
serosanguinous, subcutaneous,
extra-periosteal fluid collection with
poorly defined margins caused by
the pressure of the presenting part
of the scalp against the dilating
cervix during labor.
• It does not indicate damage of the
brain or the bones of the cranium.
11. Signs & Symptoms
• Scalp swelling that extends across the midline and over
suture lines.
• Soft and puffy swelling of part of a scalp in a newborns
head.
• May be associated with increased molding of the head.
• The swelling may or may not have some degree of
discoloration or bruising.
• Tends to disappear within 24-36 hours and tends to
reduce to size.
12. Management
• Needs no treatment. The edema is gradually absorbed
and disappears about the third day of life.
• Advice not to applying pressure over caput.
• Mother is very anxious so we must explain about what it
is, its causes in simple language.
• Baby should be handled gently apply dressing on
abrasions.
• An abraded caput usually heals rapidly if the area is kept
clean, dry & is irritated.
• Advice the mother that caput need no treatment and
disappear within 36 hours of birth.
13. CEPHALHEMATOMA
• 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.
• A cephalhaematoma never
extends beyond the edges
of the bone or crosses
suture lines.
14. Signs & Symptoms/Management
• Swelling of the infants head
24-48 hours after birth
• Discoloration of the swollen
site due to presence of
coagulated blood
• Has clear edges that end at
the suture lines
15. Management
• Observation and support of the affected part
• The condition resolves in time period of a week to two
months
16. Subgaleal hematoma
Bleeding in the
potential space
between skull
periosteum & scalp
galea aponeurosis
Crossing the
suture lines.due to
rupture of emmisar
veins
17. • (і) Diffuse swelling of the head. Sutures usually are
not palpable. The amount of blood under the scalp is
far more than is estimated. Within 48 hours the blood
tracks between the fibres of the occipital and frontal
muscles causing bruising behind the ears, along the
posterior hair line and around the eyes.
18. ii) Shock and pallor: tachycardia, a low blood
pressure, within 30 minutes of the haemorrhage the
haemoglobin and packed cell volume start to fall
rapidly.
Management
• Transfusions may be required if blood loss is
significant.
• In severe cases, surgery may be required to cauterize
the bleeding vessels.
19. Intracranial hemorrhages
• A intracranial hemorrhage
can occur due to the
immaturity of the structure
or the hemodynamic
instability, and also
secondary to trauma or
hypoxia.
20. • Causes:
1. Sudden compression and decompression of the
head as in breech and precipitate labour.
2. Marked compression by forceps or in cephalopelvic
disproportion.
3. Fracture skull.
• External to the brain into the epidural, subdural or
subarachnoid space.
• In to the parenchyma of the cerebrum or cerebellum.
• Into the ventricles or choroid plexus.
21. Intracranial Haemorrhage Sites:
• Subdural hemorrhage: It is a life
threatening collection of blood in the
subdural space. It mostly occurs due
to tearing of large veins in tentorium
cerebelli and the dural membrane
that seperates cerebrum and
cerebellum.
• Subarachnoid
hemorrhage: A subarachnoid
hemorrhage is a bleed between the
arachnoid membrane and the pia
mater which surrounds the brain.
• Epidural hemorrhage: It is a
condition where blood accumulates
between the dura and the calvarial
bone
22. Management
• Maintain ABC.
• Seizures are aggressively treated with anticonvulsant
drugs.
• Anemia and coagulopathies requires transfusion with
packed red blood cells or fresh frozen plasma.
• Shock and acidosis are treated with slow
administration of sodium bicarbonate and fluid
resuscitation.
23. Depressed skull fractures
• Depressed skull fractures are fractures or indentions of
the skull that result in bone fragments depressed into the
underlying brain tissue
.
24. Treatment and Management
• Treatment is conservative in
symptom less cases. In
presence of symptom, the
depressed bone has to be
elevated or subdural
hematoma may have to be
aspirated or excised surgically
25. INJURY TO THE NERVES
• Facial palsy
• Brachial palsy
• Erbs palsy
• Klumpke ’s palsy
26. FACIAL PALSY
• It is also known as Bell’s palsy.
The facial nerve may injured by
direct pressure of the forceps
blades or by hemorrhage or
edema around the nerve. It may
occur in normal delivery with
much pressure on the ramus of
the mandible where the nerve
crosses superficially.
27. Clinical features
• There is unilateral facial weakness with the eyelid of the
affected side remaining open and mouth drawn over to
the normal side.
• The paralyzed side is smooth.
• On crying the mouth is drawn to the uninjured side of the
face.
• If the baby cannot form an effective seal on the nipple or
treat, there may be some initial feeding difficulties.
28. Management
• There is no special treatment, improve the conduction on
1 to 2 weeks.
• Protect the eyes, which remain open even during sleep,
with antiseptic ointment.
• Feeding difficulties are usually overcome by the baby’s
own adaptation, although alternative feeding position can
be adopted.
• Maintain oral hygiene.
• If instrumental delivery and the baby have any injury,
clean and dress with antiseptic lotion.
• The condition usually disappears within weeks unless
complicated by intracranial hemorrhage.
29. BRACHIAL PALSY
• The damage occur in the brachial
nerve roots in the trunk of the
brachial plexus due to stretching
or effusion or hemorrhage inside
the nerve sheath or tearing of the
fibers. Sometimes tearing of the
fiber is rare. This causes the
hyperextension of the neck during
attempted delivery of shoulder
dystocia or even in spontaneous
vaginal delivery or during difficult
breech extraction.
• Unilateral involvement is
common.
30. Erb’s palsy
• This is the commonest type
when the 5th and 6th cervical
nerve roots are involved. The
resulting paralysis causes the
arm to lie on the side with
extension of the elbow, pronation
of the forearm and the flexion of
the wrist.
• The Moro reflex and biceps
jerks are absent on the affected
side. The arm is inwardly rotated
and the half closed hand turned
outwards.
31. • The cause of Erb’s palsy are twisted on neck in delivery of
after coming head, excessive lateral flexion of the neck
when delivering the shoulder in vertex presentation and
forceps delivery.
32. Treatment
• Use of a splint so as to hold the
arm abducted to a right angle and
externally rotated, the forearm is
flexed at right angle and supinated
and the hand is dorsiflexed.
• Massage and passive movement
are useful.
• Full recovery takes weeks or even
months.
• Severe injury may produce
permanent disability.
33. Klumpke’s palsy
• It occurs due to damage of 7th or
8th cervical or 1st thoracic nerve
roots. The features are paralysis of
the muscles of the forearm with
wrist drop and flaccid digits.
• The arm is flexed at the elbow, the
wrist extended with flaccid hands
and flexed fingers.
34. Management
•
• Splinting of arm and placing of cotton ball in the baby’s
hand to avoid contractures.
• Massage and passive movement are useful.
• Prognosis is usually good, but the permanent deformity
may persist in severe laceration of nerve and
hemorrhage. The lesions of upper brachial plexus have a
better prognosis than those of lower or total plexus. If the
paralysis persist more than 3 months, neuroplasty is
indicated.
35. FRACTURES
• Skull Fractures : Fracture of the vault of the skull in frontal or
anterior part of the parietal bone may be of fissure or depressed type.
•Spine Fractures
• Fracture of the odentiod process or fracture dislocation of the 5th – 6th
cervical vertebrae may occur due to acute bending of the spine while
delivering the after coming head, the result is instantaneous death of
the baby due to compression on the medulla.
• Long Bone Fractures
• Bones commonly involved in fractures are humerus, clavicle and
femur. These occur in breech delivery.
• Fractures are usually of greenstick type but may be complete.
• Rapid union occurs with callus information.
• Deformity is a rarity even where the bone ends are not in good
aligment.
36. Laryngeal nerve injury
Symptoms
• Stridor
• respiratory distress
• hoarse cry
• dysphagia,
• Aspiration
Treatment
• Small frequent feedings may be required to decrease the risk of
aspiration.
• Intubation
• Tracheostomy
• Bilateral paralysis tends to produce more severe distress, and
therefore requires intubation and tracheostomy placement more
frequently
37. Treatment and Management
• Skull Fractures: Treatment is conservative in symptom
less cases. In presence of symptom, the depressed bone
has to be elevated or subdural hematoma may have to be
aspirated or excised surgically.
• In clavicle fracture: A pad of cotton or wool is placed
in the axilla and the upper arm is lightly bandaged to the
side of the chest.
• In fracture Femur: The whole length of the affected
limbs may be bandaged to the front of the abdomen or
may be flexed by a posterior cast . Healing usually occurs
in about 3 weeks.
• Fracture of the humerus is treated by bandagining
the arm to the side of the chest.
39. Injury to the internal Organs
• Liver, kidney, adrenal or lungs are commonly injured
mainly during breech delivery. The most common result of
the injury is hemorrhage, severe hemorrhage is fatal. In
minor hemorrhage, the baby presents features of blood
loss in addition to the disturbed function of the organ
involved.
Treatment is directed
• To correct hypovolemia and anemia.
• Specific management – surgical or otherwise, to tackle
the injured viscera.
40. Subconjunctival hemorrhage
• Breakage of small blood vessels in
the eyes of a baby. One or both of the
eyes may have a bright red band
around the iris.
• This is very common and does not
cause damage to the eyes.
• The redness is usually absorbed in a
week to ten days
41. Nasal Septal dislocation
• Involves dislocation of the triangular cartilaginous portion
of the septum from the vomerine groove.
Clinical features
• airway obstruction.
• deviation of the nose to one side.
• The nares are asymmetric, with flattening of the side of the
dislocation (Metzenbaum sign). Application of pressure on the
tip of the nose (Jeppesen and Windfeld test) causes collapse of
the nostrils, and the deviated septum becomes more apparent.
Management
• Definitive diagnosis can be made by rhinoscopy
• manual reduction
