Top Banner
Neonatal Birth Injuries Neonatal Birth Injuries Dr. Dr. Saad Saad Alsaedi Alsaedi
25

Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Mar 25, 2020

Download

Documents

dariahiddleston
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Neonatal Birth InjuriesNeonatal Birth Injuries

Dr. Dr. SaadSaad AlsaediAlsaedi

Page 2: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

•• Inappropriate or deficient medical skill or attentionInappropriate or deficient medical skill or attention

•• They may occur, despite They may occur, despite skilled and competent obstetric competent obstetric

carecare

Birth injuries may result fromBirth injuries may result from

Page 3: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Predisposing factorsPredisposing factors

•• MacrosomiaMacrosomia

•• PrematurityPrematurity

•• Cephalopelvic disproportionCephalopelvic disproportion

•• DystociaDystocia

•• Prolonged laborProlonged labor

•• MalpresentationMalpresentation (breech, transfers lie)(breech, transfers lie)

Page 4: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Cranial InjuriesCranial Injuries

Page 5: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

ErythemaErythema, Abrasions, , Abrasions, EcchymosesEcchymoses

•• Of facial or scalp soft tissues may be seen after Of facial or scalp soft tissues may be seen after

forceps or vacuumforceps or vacuum--assisted deliveries assisted deliveries

•• Their location depends on the area of Their location depends on the area of

application of the forcepsapplication of the forceps

Page 6: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first
Page 7: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

CephalohematomaCephalohematoma

•• subperiostealsubperiosteal hemorrhagehemorrhage

•• IIt may result from difficult vacuum or forceps extraction t may result from difficult vacuum or forceps extraction

•• Does not cross the suturesDoes not cross the sutures

•• always limited to the surface of one cranial bonealways limited to the surface of one cranial bone

•• swelling is not visible until several hours after birthswelling is not visible until several hours after birth

Page 8: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first
Page 9: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

•• Most cephalohematomas are resorbed within Most cephalohematomas are resorbed within

2 2 -- 12 wk depending on their size12 wk depending on their size

•• They may begin to calcify by the end of the 2nd wkThey may begin to calcify by the end of the 2nd wk

•• central depression suggesting( but not central depression suggesting( but not

indicative )of an underlying fracture or bony indicative )of an underlying fracture or bony

defectdefect

CephalohematomaCephalohematoma

Page 10: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Management:Management:

•• usually resolves spontaneously usually resolves spontaneously

•• phototherapy if Jaundicedphototherapy if Jaundiced

•• Blood transfusion if anemic due to severe Blood transfusion if anemic due to severe

hemorrhage hemorrhage

•• Incision and drainage are contraindicatedIncision and drainage are contraindicated

CephalhaematomaCephalhaematoma

Page 11: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Peripheral Nerve Peripheral Nerve

InjuriesInjuries

Page 12: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Risk Factors Associated

With Perinatal Brachial Plexus

Maternal Factors

• Excessive maternal weight gain

• Maternal diabetes

• Uterine abnormalities

• Past history of PBPP

Page 13: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Risk Factors Associated

With Perinatal Brachial Plexus

Fetal Factors

• Fetal macrosomia

Parturitional Factors

• Shoulder dystocia

• Prolonged labor

• Assisted delivery with forceps or vacuum

• Breech delivery

Page 14: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Brachial Plexus Palsy:Brachial Plexus Palsy:

It is due to over traction on the neck as in:It is due to over traction on the neck as in:

1.1. Shoulder Shoulder dystociadystocia

2.2. AfterAfter--coming head in breech deliverycoming head in breech delivery

Page 15: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

•• due to injury to C5 and C6 rootsdue to injury to C5 and C6 roots

•• Adduction and internal rotation of the arm with Adduction and internal rotation of the arm with pronationpronationof the forearm of the forearm

•• The upper limb drops beside the trunk, internally rotated The upper limb drops beside the trunk, internally rotated with flexed wrist with flexed wrist (policeman(policeman’’s or waiters or waiter’’s tip hand)s tip hand)

•• Moro reflex is absent on the affected sideMoro reflex is absent on the affected side

Erb'sErb's palsypalsy

Page 16: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first
Page 17: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first
Page 18: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Treatment:Treatment:

•• Support to prevent stretching of the paralyzed Support to prevent stretching of the paralyzed

musclesmuscles

•• Physiotherapy: massage, exercise and faradic Physiotherapy: massage, exercise and faradic

stimulationstimulation

Brachial Plexus Palsy:Brachial Plexus Palsy:

Page 19: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

If the paralysis persists without improvement for 3If the paralysis persists without improvement for 3--6 months:6 months:

neuroplastyneuroplasty, neurolysis, end, neurolysis, end--toto--end anastomosis, or nerve end anastomosis, or nerve

graftinggrafting

offers hope for partial recovery.offers hope for partial recovery.

TreatmentTreatment

Page 20: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

The prognosisThe prognosis

•• Depends on whether the nerve was merely Depends on whether the nerve was merely

injured or was laceratedinjured or was lacerated

•• If the paralysis was due to edema and If the paralysis was due to edema and

hemorrhage about the nerve fibers, function hemorrhage about the nerve fibers, function

should return within a few monthsshould return within a few months

•• If due to laceration, permanent damage may If due to laceration, permanent damage may

result.result.

Page 21: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

Fracture ClavicleFracture Clavicle

Difficulty in delivery of:Difficulty in delivery of:

•• the shoulder in vertex presentations the shoulder in vertex presentations

•• The extended arms in breech deliveriesThe extended arms in breech deliveries

Page 22: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first
Page 23: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

•• The infant characteristically does not move the The infant characteristically does not move the

arm freely on the affected side;arm freely on the affected side;

•• Crepitus and bony irregularity may be palpated, Crepitus and bony irregularity may be palpated,

and and

•• Discoloration is occasionally visible over the Discoloration is occasionally visible over the

fracture sitefracture site..

Fracture ClavicleFracture Clavicle

Page 24: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first

•• No interventionNo intervention

•• immobilization of the arm and shoulder on the immobilization of the arm and shoulder on the

affected side affected side

•• A remarkable degree of callus develops at the A remarkable degree of callus develops at the

site within a week and may be the first evidence site within a week and may be the first evidence

of the fracture of the fracture

•• The prognosis is excellentThe prognosis is excellent

Fracture ClavicleFracture Clavicle

Page 25: Neonatal Birth Injuries - kau injuries.pdf · Neonatal Birth Injuries Dr. Saad Alsaedi ... • A remarkable degree of callus develops at the site within a week and may be the first