Pediatrics

1. NEONATOLOGY
AND CHILD HEALTH
(3 CHRS)
Birth Trauma

2. 2
Caput succedaneum
 An edematous swelling on the presenting portion
of the scalp of an infant during birth, caused by
the pressure of the presenting part against the
dilating cervix. The effusion overlies the
periosteum with poorly defined margins.
 Caput succedaneum extends across the midline
and over suture lines. Caput succedaneum does
not usually cause complications and usually
resolves over the first few days. Management
consists of observation only.

3. 3
Cephalhematoma:
Cephalhematoma is a subperiosteal collection
of blood secondary to rupture of blood vessels
between the skull and the periosteum, in which
bleeding is limited by suture lines (never cross
the suture lines).

4. 4

5. Duchenne-Erb paralysis
Injury to the 5th and 6th cervical nerves
Affected arm is adducted, internally
rotated
Forearm is in pronation
Wrist is flexed
Arm falls limply to the side of the body
when passively adducted
Moro, biceps and radial reflexes absent

6. Klumpke’s paralysis
 injury to the 7th and 8th cervical and 1st thoracic
spinal nerves
 Horner syndrom (ipsilateral ptosis and miosis) if
the sympathetic fibers of the 1st thoracic root are
also injured
 Absent of movements of the wrist

7. Treatment
 Infant evaluated every month and if no
improvement in deltoid, biceps and triceps
function occurs by 3rd month, good outcome
without surgery is not likely
 Primary brachial plexus exploration during
the fourth month

8. Clavicular fracture
Most common
Crepitus, palpable bony irregularity
sternoclaidomastoid muscle spasm
Cry during movement of upper extremities

9. Injuries to intra-abdominal organs
 Rupture of the liver- large infants,
IDM,breech
 Affected infant may appear normal for the
1st 1-3 days of life, any infant with shock,
abdominal distension, pallor, anemia, and
irritability with no evidence of blood loss
 Abdomen is rigid, bluish discoloration of the
overlying skin.
 CT scan may help in diagnosing
subcapsular hematoma

10. Treatment
 Prompt transfusion of prbcs and correction of
coagulation disorder
 Laparotomy with evacuation of the hematoma
and repair of any lacerations
 Any fragmented, devitalized liver tissue should
be removed
 Blood transfusion and the tamponade of intra-
abdominal pressure might be adequate therapy
in some infants

11. Rupture of the spleen
 Large infants in breech position,
erythroblastosis, congenital syphilis
 Underlying clotting defect
 Clinical signs of hemoperitoneum and blood loss
 Left upper quadrant mass and medial
displacement of the gastric bubble
TREATMENT
 Packed rbc’s and exploratory laparotomy
 Attempt to repair and preserve the spleen

12. Adrenal hemorrhage
 Risk factors: Macrosomic, IDM, cong syphilis,
neuroblastoma, hemorrhagic disease
 Symptoms: Fever, tachypnea, cyanosis, mass in
flank and purpura
 Adrenal insufficiency, poor feeding, vomiting,
uremia, convulsions and shock
 U/S- initially solid appearance then cystic
Treatment:
 Blood , IVF and corticosteroids
 Laparotomy, evacuation of clots if extends to
peritoneal cavity

13. I don’t want a trauma