Birth trauma of the newbom. Flashcards
what is caput succedunum ?
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
when is caput succedaneum usually seen ?
prolonged labour in full term or preterm infants
what is the treatment for caput succedaneum ?
the edema vanishes within couple of days without anything.
what is cephalohematoma ?
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
what can be seen under the cephalohematoma ?
a linear skull fracture
what causes cephalohematoma
prolonged labour
instrumental delivery such as forceps and suctioning
what is the treatment of cephalohematoma ?
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
what are the other common haemorrhage injuries ?
retinal and subconjuctval haemorrhage which usually resolves on its own
why does spinal cord and spinal injuries occur in neonates
result of hyperextended posture
fractures of the vertebrae and spinal cord innjuries leading to neurological dysfunction have signs such as ?
absence of deep tendon reflexes
absence of response to painful stimuli
if not fatal with time - bowel and bladder problems
spasticity
hyperreflexia
what causes brachial plexus injury ?
traction of the neck
what do you call the brachial plexus paresisi of C5-C6 ?
erb - Duchenne paralysier
what are the signs and symptoms of C5-C6 paralysis ?
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
what are the all the vertebrae affecting the phrenic nerve palsy ?
c3 ,c4 , c5
what leads to phrenic nerve palsy ?
paralysis of the diaphragm = respiratory distress
what is the klumpke paralysis
injury to the cervical nerves of c7-c8 and TH1
in klumpke paralysis what are the signs and symptoms ?
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
what is the treatment from klumpke paralysis
fixation by the flexion of the affected arm for 10 days
facial nerve is a result of which nerve ?
7th cranial nerve
what causes facial nerve palsy ?
use forceps
what are the signs and symptoms of facial nerve palsy ?
asymmetric crying face
affected side is flaccid
eye does not close
nasolabial fold
what is complication of facial nerve palsy ?
protecting the conjuctivitis
if there is any fracture to the cranium of the baby do we treat it ?
require no treatment
are fractures of the cranium a common thing ?
it is rare and usually LINEAR
a very a common fracture of the baby ?
clavicle unilateral
humerus
femur
fracture of the clavicle is common in what type of babies ?
macrocosmic babies - shoulder dystocia
what is the signs and symptoms of clavicular fractures ?
asymmetric moro reflex , decreased movement of the affected side
what are the different types of intracranial haemorrhage ?
subdural subarachnoid epidural parenchymal intraventricular
what cause subdural haemorrhage ?
forceps
cephalopelvic disproportion
large gestational age
skull fractures
hypoxemic ischemic encephalopathy
breech
malpresentation
c section
why is subdural haemorrhage very dangerous ?
water is drawn into the haemorrhage because of the high oncotic pressure of the protein
resulting in expanding symptomatic lesion
what are the signs and symptoms of subdural haemorrhage ?
macrocephaly
pushing against the brain vomitting seizures resp depression apnea irritability hypotonia decreased level consciousness
massive - shock , seizures , coma
what is the diagnosis of subdural haemorrhage
lab :
anemia
jaundice
ultrasound and ct
do we treat subdural haemorrhage ?
surgical evacuation
complication of subdural haemorrhage
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
hat causes subarachnoid haemorrhage ?
birth trauma - mechanical force hypodermic ischemic encephalopathy fetal malpresentation cephalopelvic diporption atriovenous malformations
what are the signs and symptoms of subarachnoid heorrhages ?
seizures
apnea
bradycardia
hydrocephalus
what is the prognosis of subarachnoid heorrhages ?
minor
and babies usually survive without lasting problems
what causes periventricular and intraventricular haemorrhages
preterm babies very low birth weight = esp below 1500g asphyxia hypoxemia = RDS hypercapnia heart failure
when does periventricular and intraventricular hemorrhage most commonly occur ?
1-3 days of life
what is the clinical manifestations of periventricular and intraventricular haemorrhages
seizures apnea bradycardia lethargy coma hypotension metabolic acidosis anemia bulging fontanel macrocephaly
what is the treatment for PVH or IVH ?
spinal tap
if necessary ventricular peritoneal shunt
what is the pathophysiology of HIE ?
hypoxia to the brain leads to reduced glucose for metabolism and lactate builds up giving anaerobic metabolism and tissue acidosis
what are the characteristics of hypoxermic ischemic encephalopathy in a TERM infant ?
cerebral edema
cortical necrosis and involvement of basal ganglia
what is hypodermic and ischemic encephalopathy characterised in preterm infants ?
periventricular leukomalacia
in both preterm and full term babies what is the rest of hypodermic ischemic encephalopathy ?
cortical atrophy
mental retardation
spastic quadriplegia
diplegia
what causes hypodermic ischemic encephalopathy
alcohol
smoking
birth asphyxia
what are the signs and symptoms and using this can give the particular staging in hypodermic ishemic encephalopathy their stages ?
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
what is the diagnosis
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
what is the treatment for HIE?
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
what is a big complication in HIE?
cerebral palsy
