17. Birth trauma.

Question 1

Caput Succedaneum

Answer 1

• diffuse, edematous, often dark swelling o the soft tissue of the scalp
• extends accross the midline & suture lines
• most often seen in prolonged labor
• associated to moldin gof the head
• no specific treatment is required
• the premature infant may develop a massive hemorrhage

Question 2

Cephalhematoma

Answer 2

• subperiostal hemorrhage that does not cross the suture lines surrounding the respective bones
• a linear fracture underlying a cephalhematoma may rarely be seen
• may organize, calcify & cause a central depression
• may cause indirect bilirubinemia

Question 3

Birth Injuries

Spinal cord injuries

Injuries to the spine

Answer 3

Causes:

• overextended, star-gazing posture
• rotational (C3-C4) or longitudinal forces in breech and vertex

Symptoms:

• ⇒ flaccidity, complete paralysis & abscence of deep tendon reflexes below that lesion, non-responsiveness to stimuli
• often also flaccid, apneic & asphyxiated
  
  • may mask the underlying spinal cord injury

Question 4

Injury to the brachial plexus

Answer 4

caused by excessive traction on the neck

results in paresis/paralysis

mildest form: Neuraprasia - Edema

more severe: oxometmesis - CO

Neurotmesis/complete nerve disruption or root avulsion

Question 5

Erb-Duchenne Paralysis

Answer 5

• 5th and 6th cervical nerves are damaged
• most common and usually mildest injury
• infant cannot:
  
  • abduct the arm at the shoulder
  • externally rotate the arm
  • supinate the forearm
• absent Moro on the affected side
• intact grasp-reflex

Question 6

Phrenic Nerve Palsy

Klumpke Paralysis

Answer 6

Phrenic Nerve Palsy

• C3 - C5
• may lead to diaphragmic paralysis & respiratory distress

Klumpke Paralysis

• Injury to 7th & 8th cervical & 1st thoraic nerves
• causes:
  
  • paralysed hand
  • (ipsilateral Horner-syndrome)
    
    • if the sympathetic Nn. are injured
    • Ptosis & miosis

Question 7

Facial Nerve Injury

Answer 7

• may be the result of compressin of the 7th nerve between the facial bone and the mother’s pelvic bones/foreceps
• leads to asymetric crying face
• the unaffected side moves normally
• affected side
  
  • is flaccid
  • one eye doesn’t close
  • nasolabial fold is absent
  • side of mouse droops at rest

Question 8

Skull Fractures

Answer 8

• Skull Fractures
  
  • rare,
  • usually linear
  • require no treatment rather than observation

Question 9

Clavicular Fractures

Answer 9

Clavicular Fractures

• asymmetric moro & movement
• may require no treatment
• or just a figure eight bandage

Question 10

Extremity Fractures

Answer 10

Extremity Fractures

• immobilisation &
• triangular splint bandage for humerus
• traction suspension of legs & femur

Question 11

Visceral Trauma

Answer 11

• liver, spleen, adrenal glands
• occurs most commonly in macrosomic & premature infants
• Anemia + Shock + normal head US
  
  • think about hepatic/splenic rupture
• Adrenal hemorrhage may be asymptomatic