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pediatrics > Birth trauma of the newbom. > Flashcards

Birth trauma of the newbom. Flashcards

1
Q

what is caput succedunum ?

A

it is a diffuse edematous often dark swelling

the edema is often between th periosteum and the overlying skin
during labour the high pressure on the head ceases the venous drainage

it usually extends across the midlines and the suture line

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2
Q

when is caput succedaneum usually seen ?

A

prolonged labour in full term or preterm infants

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3
Q

what is the treatment for caput succedaneum ?

A

the edema vanishes within couple of days without anything.

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4
Q

what is cephalohematoma ?

A

haemorrhage underneath the periosteum , from the damage of the subperiosteal vessels

because the swelling is periosteal the swelling is restricted to the boundaries of the bones unlike caput succedenum - it does not cross the suture lines

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5
Q

what can be seen under the cephalohematoma ?

A

a linear skull fracture

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6
Q

what causes cephalohematoma

A

prolonged labour

instrumental delivery such as forceps and suctioning

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7
Q

what is the treatment of cephalohematoma ?

A

typically resolves spontaneously but recommended to aspirate the blood to reduce the calcification especially is there is a linear fracture beneath the cephaloheamtoma may organise and calcify and form a central depression

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8
Q

what are the other common haemorrhage injuries ?

A

retinal and subconjuctval haemorrhage which usually resolves on its own

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9
Q

why does spinal cord and spinal injuries occur in neonates

A

result of hyperextended posture

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10
Q

fractures of the vertebrae and spinal cord innjuries leading to neurological dysfunction have signs such as ?

A

absence of deep tendon reflexes
absence of response to painful stimuli

if not fatal with time - bowel and bladder problems
spasticity
hyperreflexia

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11
Q

what causes brachial plexus injury ?

A

traction of the neck

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12
Q

what do you call the brachial plexus paresisi of C5-C6 ?

A

erb - Duchenne paralysier

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13
Q

what are the signs and symptoms of C5-C6 paralysis ?

A

cannot abduct the arm at the shoulder
cannot externally rotate the arm
or supinate the forearms
= waiter tip hand

absent moro reflex on involved side

so the clinical presentation is adducted , internally roasted and pronated arm

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14
Q

what are the all the vertebrae affecting the phrenic nerve palsy ?

A

c3 ,c4 , c5

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15
Q

what leads to phrenic nerve palsy ?

A

paralysis of the diaphragm = respiratory distress

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16
Q

what is the klumpke paralysis

A

injury to the cervical nerves of c7-c8 and TH1

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17
Q

in klumpke paralysis what are the signs and symptoms ?

A

paralysed hand and arm - affects the intrinsic muscles and represents a claw hand
forarm is supinate and wrist and fingers are hyperextended and flexion and the interphalneag and metatarsophalanageal joints are flexed

if sympathetic nerves affects - ipsilateral horner syndrome 
= ptosis = drooping of the eyelid 
meiosis = constricted pupils
= missing gasping relief 
= decreased sweating
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18
Q

what is the treatment from klumpke paralysis

A

fixation by the flexion of the affected arm for 10 days

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19
Q

facial nerve is a result of which nerve ?

A

7th cranial nerve

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20
Q

what causes facial nerve palsy ?

A

use forceps

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21
Q

what are the signs and symptoms of facial nerve palsy ?

A

asymmetric crying face
affected side is flaccid
eye does not close
nasolabial fold

22
Q

what is complication of facial nerve palsy ?

A

protecting the conjuctivitis

23
Q

if there is any fracture to the cranium of the baby do we treat it ?

A

require no treatment

24
Q

are fractures of the cranium a common thing ?

A

it is rare and usually LINEAR

25
Q

a very a common fracture of the baby ?

A

clavicle unilateral
humerus
femur

26
Q

fracture of the clavicle is common in what type of babies ?

A

macrocosmic babies - shoulder dystocia

27
Q

what is the signs and symptoms of clavicular fractures ?

A

asymmetric moro reflex , decreased movement of the affected side

28
Q

what are the different types of intracranial haemorrhage ?

A 
subdural 
subarachnoid 
epidural 
parenchymal 
intraventricular
29
Q

what cause subdural haemorrhage ?

A

forceps
cephalopelvic disproportion
large gestational age
skull fractures

hypoxemic ischemic encephalopathy

breech
malpresentation

c section

30
Q

why is subdural haemorrhage very dangerous ?

A

water is drawn into the haemorrhage because of the high oncotic pressure of the protein
resulting in expanding symptomatic lesion

31
Q

what are the signs and symptoms of subdural haemorrhage ?

A

macrocephaly

pushing against the brain vomitting 
seizures 
resp depression 
apnea 
irritability 
hypotonia 
decreased level consciousness

massive - shock , seizures , coma

32
Q

what is the diagnosis of subdural haemorrhage

A

lab :
anemia
jaundice

ultrasound and ct

33
Q

do we treat subdural haemorrhage ?

A

surgical evacuation

34
Q

complication of subdural haemorrhage

A

hypoxermic ischemic encephalopathy
brain hernia

all types of bleeding in the brain can increase the risk for
permeant brain damage
cerebral palsy
developmental delay s

35
Q

hat causes subarachnoid haemorrhage ?

A 
birth trauma - mechanical force 
hypodermic ischemic encephalopathy 
fetal malpresentation 
cephalopelvic diporption 
atriovenous malformations
36
Q

what are the signs and symptoms of subarachnoid heorrhages ?

A

seizures
apnea
bradycardia
hydrocephalus

37
Q

what is the prognosis of subarachnoid heorrhages ?

A

minor

and babies usually survive without lasting problems

38
Q

what causes periventricular and intraventricular haemorrhages

A 
preterm babies 
very low birth weight = esp below 1500g 
asphyxia 
hypoxemia = RDS
hypercapnia 
heart failure
39
Q

when does periventricular and intraventricular hemorrhage most commonly occur ?

A

1-3 days of life

40
Q

what is the clinical manifestations of periventricular and intraventricular haemorrhages

A 
seizures 
apnea
bradycardia 
lethargy 
coma 
hypotension 
metabolic acidosis 
anemia 
bulging fontanel 
macrocephaly
41
Q

what is the treatment for PVH or IVH ?

A

spinal tap

if necessary ventricular peritoneal shunt

42
Q

what is the pathophysiology of HIE ?

A

hypoxia to the brain leads to reduced glucose for metabolism and lactate builds up giving anaerobic metabolism and tissue acidosis

43
Q

what are the characteristics of hypoxermic ischemic encephalopathy in a TERM infant ?

A

cerebral edema

cortical necrosis and involvement of basal ganglia

44
Q

what is hypodermic and ischemic encephalopathy characterised in preterm infants ?

A

periventricular leukomalacia

45
Q

in both preterm and full term babies what is the rest of hypodermic ischemic encephalopathy ?

A

cortical atrophy
mental retardation
spastic quadriplegia
diplegia

46
Q

what causes hypodermic ischemic encephalopathy

A

alcohol
smoking

birth asphyxia

47
Q

what are the signs and symptoms and using this can give the particular staging in hypodermic ishemic encephalopathy their stages ?

A

SARNAT staging

level of consciousness
stage 1 - hyper alert
2- lethargic
3- stuporous

muscle tone
stage1 - normal
2 - hypotonic
flaccid

tendon reflex
stage 1 - hyperactive
hyperactive
absent

moro reflex
stage 1 - strong
2 - weak
3- absent

pupils
stage 1 - mydriasis -
miosis
poor light reflex

seizures
stage 1 - non
common - peak at 48 hours
decerebration

duration
stage 1 - 24 and longer
stage 2 - 24hr-14 days
stage 3 - days to weeks

difficulty initiating and maintaining respiration

48
Q

what is the diagnosis

A

electroencephalograph in secures
stage 1 - normal
stage 2 0 low voltage changing seizure activity
burst suppression to isoelectric

blood gas analysis
cord blood gas analysis for high risk pregnancy
CT , MRI

49
Q

what is the treatment for HIE?

A

hypothermia therapy - cooling the baby to 33 degrees for three days after birth

decrease the cerebral metabolic date for glucose and oxygen reduce the high energy loss of phosphates during hypoxia and ischemia

50
Q

what is a big complication in HIE?

A

cerebral palsy

pediatrics (19 decks)

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