11 Injuries of the newborn Flashcards
what are the mechanical injures of the new born ?
mechanical injuries -
caput succedaneum , cephalohematoma ,
intracranial hemorrhages
torticollis , fractures
nerve injuries - brachial plexus paresis
phrenic nerve paresis
facial nerve paresis
what is caput succedaneum ?
edema with poorly defined margins located between the skin and epicranial aponeurosis l
what causes caput succedenum?
during labour venous I drainage of the blood from the head can be stopped due to the high pressure - resulting in edema
what is the treatment for caput succedaneum ?
edema vanishes in couple of days without testament and not clinically significant
what is Cephalohematomas ?
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
what causes Cephalohematomas ?
prolonged second stage of labour or instrumental delivery - forceps
lead to damage of subperiosteal vessels( NOT ventouse)
is cephalohematoma present at birth ?
never present at birth develops 12-24hrs
what is the treatment for Cephalohematomas ?
typically resolves spontaneously - but recommenced to aspirate the blood to reduce the risk of calcification
treatmnet for hyperbilirubinemia may be needed or anemia
cephalohematoma dd and how to know the difference /
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
what is torticollis ?
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
what causes torticollis ?
breech delivery
shoulder dystocia delivery
excessive lateral flexion of the neck during normal delivery
what is the clinical management of torticollis ?
physiotherapy stretching go the muscle
surgery is performed on those who are over 12 months old.- who does not respond to physiotherapy
what are the different types of fractures which common in a baby ?
clavicule fractures most common
then humerus
then femur
what is a complication of clavicle fractures ?
injury to the brachial plexus
what is the treatment for fractures fractures ?
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
what causes brachial plexus paresis?
traction of the neck when delivering the shoulder - hyperextension of the neck to one side
with extension and abduction of the arm
what is the classification of brachial plexus ?
upper brachial plexus c5-c6
erbs palsy - most common
lower bronchial plexus affects c8 t1 -klumpe play
what re the signs and symptoms of erbs palsy ?
waiters tip - adducted arm abs internally rotated extended elbow and flexion of wrist Weak biceps brachii and brachialis and brachioradialis
what are the signs and symptoms for klumpke palsy ?
claw hand -
forarm supinatied
flexion of interphalangeal and metacarpophalangeal joints
Horner syndome - meiosis , ptosis, facial anhydrosis
what is the treatment for brachial plexus paresis
resolves spontaneously if due to stretching but due to hemorrhage may be permanent
immobilisation is the treatmnet and physiotherapy afterwords
for phrenic never palsy what vertebral nerves are affected ?
c3, c4 or c5
what causes phrenic nerve palsy
excessive stretching of the neck at birth. Risk factors are: Breech or difficult forceps delivery.
paresis of the phrenic nerve leads to what ?
malfunction of the diaphragm affecting respiration
what are the signs and l symptoms of phrenic nerve palsy ?
respiratory distress, cyanosis and tachypnea.
diagnosis of phrenic nerve palsy ?
USG showing paradoxical movement of the diaphragm.
what is the treatment of phrenic nerve palsy ?
usually resolves in 1-3 months till then
CPAP and mechanical ventilation
what causes paresis of facial nerve ?
use of forceps
diagnosis of facial nerve palsy ?
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.
what is the treatment for facial nerve palsy ?
protect the conjuctiva with eye cover
synthetic tears (1% methyl cellulose drops
facial nerve paresis resolves within couple of days
what are the most common intracranial haemorrhages through birth injuries ?
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
what is the most common intracranial hemorrhage in preterm
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
what causes subdural hemorrhage ?
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
what are the clinical signs and symptoms of subdural hemorrhage ?
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
what are the symptoms of subarachnoid hemorrhage ?
The symptoms may appear late (1 week). : seizures, irritability and lethargy with focal neurological signs.
how do we diagnose intracranial haemorrhages as a result of birth trauma ?
US
CT
MRI
what is the treatmnet of subdural hematoma ?
subdural tap
or surgical evacuation
