11 Injuries of the newborn

Question 1

what are the mechanical injures of the new born ?

Answer 1

mechanical injuries -
caput succedaneum , cephalohematoma ,
intracranial hemorrhages

torticollis , fractures

nerve injuries - brachial plexus paresis
phrenic nerve paresis
facial nerve paresis

Question 2

what is caput succedaneum ?

Answer 2

edema with poorly defined margins located between the skin and epicranial aponeurosis l

Question 3

what causes caput succedenum?

Answer 3

during labour venous I drainage of the blood from the head can be stopped due to the high pressure - resulting in edema

Question 4

what is the treatment for caput succedaneum ?

Answer 4

edema vanishes in couple of days without testament and not clinically significant

Question 5

what is Cephalohematomas ?

Answer 5

haemorrhage between the periosteum and the epicranial aponeurosis which lies above it

limited to the boundary or suture lines of individual bones most commonly the parietal in contrast to caput succedaneum it is fixed to the margin of the bones

Question 6

what causes Cephalohematomas ?

Answer 6

prolonged second stage of labour or instrumental delivery - forceps
lead to damage of subperiosteal vessels( NOT ventouse)

Question 7

is cephalohematoma present at birth ?

Answer 7

never present at birth develops 12-24hrs

Question 8

what is the treatment for Cephalohematomas ?

Answer 8

typically resolves spontaneously - but recommenced to aspirate the blood to reduce the risk of calcification

treatmnet for hyperbilirubinemia may be needed or anemia

Question 9

cephalohematoma dd and how to know the difference /

Answer 9

meningocele -
meningocele is a protrusion of intracranial contents through a defect in the skull

always lies over the suture line or fontanel

CT and MRI

Question 10

what is torticollis ?

Answer 10

damage of the sternocleidomastoids during birth leads to intramuscular hematoma which then calcifies and thus shortens the muscle and the shortened muscle pulls the head towards its side

Question 11

what causes torticollis ?

Answer 11

breech delivery

shoulder dystocia delivery

excessive lateral flexion of the neck during normal delivery

Question 12

what is the clinical management of torticollis ?

Answer 12

physiotherapy stretching go the muscle

surgery is performed on those who are over 12 months old.- who does not respond to physiotherapy

Question 13

what are the different types of fractures which common in a baby ?

Answer 13

clavicule fractures most common
then humerus
then femur

Question 14

what is a complication of clavicle fractures ?

Answer 14

injury to the brachial plexus

Question 15

what is the treatment for fractures fractures ?

Answer 15

clavicle fractures heal very quickly without any problems , if needed traction to have closed reduction and immobilisation

the rest of the fracture may need open reduction

Question 16

what causes brachial plexus paresis?

Answer 16

traction of the neck when delivering the shoulder - hyperextension of the neck to one side
with extension and abduction of the arm

Question 17

what is the classification of brachial plexus ?

Answer 17

upper brachial plexus c5-c6
erbs palsy - most common

lower bronchial plexus affects c8 t1 -klumpe play

Question 18

what re the signs and symptoms of erbs palsy ?

Answer 18

waiters tip - 
adducted arm abs internally rotated
extended elbow 
and flexion of wrist
Weak biceps brachii and brachialis and brachioradialis

Question 19

what are the signs and symptoms for klumpke palsy ?

Answer 19

claw hand -
forarm supinatied
flexion of interphalangeal and metacarpophalangeal joints
Horner syndome - meiosis , ptosis, facial anhydrosis

Question 20

what is the treatment for brachial plexus paresis

Answer 20

resolves spontaneously if due to stretching but due to hemorrhage may be permanent

immobilisation is the treatmnet and physiotherapy afterwords

Question 21

for phrenic never palsy what vertebral nerves are affected ?

Answer 21

c3, c4 or c5

Question 22

what causes phrenic nerve palsy

Answer 22

excessive stretching of the neck at birth. Risk factors are: Breech or difficult forceps delivery.

Question 23

paresis of the phrenic nerve leads to what ?

Answer 23

malfunction of the diaphragm affecting respiration

Question 24

what are the signs and l symptoms of phrenic nerve palsy ?

Answer 24

respiratory distress, cyanosis and tachypnea.

Question 25

diagnosis of phrenic nerve palsy ?

Answer 25

USG showing paradoxical movement of the diaphragm.

Question 26

what is the treatment of phrenic nerve palsy ?

Answer 26

usually resolves in 1-3 months till then

CPAP and mechanical ventilation

Question 27

what causes paresis of facial nerve ?

Answer 27

use of forceps

Question 28

diagnosis of facial nerve palsy ?

Answer 28

noting the eye of the affected side remains open and eyelids are immobile.

On crying , the angle of the mouth is drawn over to the unaffected side.

No nasolabial fold is present.

Sucking remains unaffected.

Question 29

what is the treatment for facial nerve palsy ?

Answer 29

protect the conjuctiva with eye cover

synthetic tears (1% methyl cellulose drops

facial nerve paresis resolves within couple of days

Question 30

what are the most common intracranial haemorrhages through birth injuries ?

Answer 30

epidural hemorrhage - rare and associated with fractured skull

subdural hemorrhage - most common - blood between the dura and arachnoid membrane

subarachnoid hemorrhage - blood between arachnoid and pa mater

Question 31

what is the most common intracranial hemorrhage in preterm

Answer 31

bleeding from a germinal matrix at the caudothalamic transition because there are tender vessels located here, but in older babies the transition is more complete

Question 32

what causes subdural hemorrhage ?

Answer 32

fracture of skull

rupture of inferior sagittal sinus

rupture of small veins in cortex

MASSIVE hemorrhage - tear of the tentorium cerebelli = opening the straight sinus or rupture of vein of GALEN
THIS IS PRIMARILY DUE TO EXCESSIVE MOLDING in deflexed vertex
RAPID DECOMPRESSION OF THE HEAD AFTER BREECH
FORCIBLE FORCEP TRACTION following wrong application of blades

Question 33

what are the clinical signs and symptoms of subdural hemorrhage ?

Answer 33

Neurological symptoms may appear acutely or insidious onset, like vomiting, i
rritability and failure to gain weight. Hydrocephalus and mental retardation may be a late sequelae.

massive hemorrhage - neck rigidity , coma , apnea , bulging fontanelle , seizures , non reactive pupils

Question 34

what are the symptoms of subarachnoid hemorrhage ?

Answer 34

The symptoms may appear late (1 week). : seizures, irritability and lethargy with focal neurological signs.

Question 35

how do we diagnose intracranial haemorrhages as a result of birth trauma ?

Answer 35

US
CT
MRI

Question 36

what is the treatmnet of subdural hematoma ?

Answer 36

subdural tap

or surgical evacuation