Birth injuries

 Cephaloheamatoma

Cephalohematoma (seh-FEL-low HE-muh-toe-muh) is blood that collects between a newborn's scalp and skull. Hematoma means blood that pools outside blood vessels. Cephalo refers to the head. This type of birth injury occurs when pressure on a baby's head ruptures blood vessels in the scalp.

What is the cause of cephalohaematoma?

The cause of a cephalohematoma is rupture of blood vessels crossing the periosteum due to the pressure on the fetal head during birth. During the process of birth, pressure on the skull or the use of forceps or a vacuum extractor rupture these capillaries resulting in a collection of serosanguineous or bloody fluid.

Sign of a cephaloheamatoma

The most obvious sign of a cephalohematoma is a soft, raised area on the newborn's head. A firm, enlarged unilateral or bilateral bulge on top of one or more bones below the scalp characterizes a cephalohematoma. The raised area cannot be transilluminated, and the overlying skin is usually not discolored or injured.

The hallmark symptom of a cephalohematoma is a protrusion or bulge in the back of a baby's head which forms soon after birth. At first the bulge (which is the pool of internal blood) will feel soft to the touch. Gradually the pooled blood under the scalp will begin to calcify and the bulge will get harder and denser.

Diagnosis

The appearance of a bulge on your baby’s head may be enough to make a diagnosis, but your doctor may order additional tests before confirming the diagnosis.

 Additional tests that your doctor may order include:

X-ray: Uses ionizing radiation to produce images of the bones and other internal structures. X-rays are painless and quick tests.

CT scan: Uses ionizing radiation to produce cross-sections of the inside of the body. CT scans include images of bones, soft tissue and blood vessels. They are quick and painless tests.

MRI: Uses magnetic waves to product images of tissue and organs inside the body. MRIs are painless, but do require around 45 minutes, which can be distressing for some people.

Ultrasound: Uses sound waves to produce images of organs and internal structures of the body. It is also the device used to view and monitor infants during pregnancy.

Imaging tests will  if there are any other problems, which will allow to confirm cephalohematoma or make another diagnosis.

Complications

Cephalohematomas do increase a baby's risk of:

• jaundice
• anemia
• infections

In rare instances, a newborn may also have a skull fracture that should heal on its own.

Infants with cephalohematoma are also at a heightened risk for developing jaundice, because as the blood cells break down the levels of bilirubin increase. In these instances, and if the bilirubin is excessively high, cephalohematoma treatment may include phototherapy.

Management 

In most instances, your newborn will not need any treatment for cephalohematoma because it goes away without any medical interventions. The bump goes away after several weeks or months. 

NB!!

One should not attempt to aspirate or drain the cephalohematoma. Aspiration is not effective because the blood has clotted. Also, entering the cephalohematoma with a needle increases the risk of infection and abscess formation.

Caput succedaneum

This is the medical term referring to swelling of the scalp during labor and shortly after delivery. Externally, it may look very similar to cephalohematoma; however, this condition is caused prolonged pressure being exerted on the infant’s head during delivery by a dialated cervix or vaginal walls. Use of forceps and vaccum extractors can also cause caput succedaneum.

Epidemiology

The reported prevalence is between 1.8% and 33.6% of all vaginal births, with the most common risk factors being maternal nulliparity and the use of vacuum delivery. Caput succedaneum may be an indicator of prolonged labor. It is rarely associated with intracranial injury.

Management

No treatment is necessary for this condition, and there should be no long-term effects. The swelling should decrease within several days, and the scalp should appear normal within days or weeks. A large or swollen head is a normal symptom of this condition.

Clavicle fracture

The clavicle is the bone that connects the breastplate (sternum) to the shoulder. It is a very solid bone that has a slight S-shape and can be easily seen in many people. It connects to the sternum at a joint with cartilage called the sternoclavicular joint.

Clavicle, also known as collar bone, fractures are most common injury sustained by newborns during birth. A clavicle fracture is a break in the collar bone and occurs as a result of a difficult delivery or trauma at birth.

Epidemiology

The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13%.

Causes

The major causes of clavicular fractures are shoulder dystocia deliveries in vertex presentations and extended arms in breech deliveries. It is usually associated with vigorous, forceful manipulation of the arm and shoulder. However, fracture of the clavicle may also occur in infants following normal delivery.

Management

In most cases, clavicle fractures in newborns heal very quickly without any problems. Usually no treatment is required; however, the parent may be instructed to pin the child's sleeve of the affected arm to the front of their clothing to avoid moving the arm while it heals.

Brachial Plexus Palsy

The brachial plexus is a group of nerves around the shoulder. A loss of movement or weakness of the arm may occur if these nerves are damaged. This injury is called neonatal brachial plexus palsy (NBPP).

Which neonates are at risk?

• Breech delivery
• Maternal obesity
• Larger-than-average newborn (such as an infant of a diabetic mother)
• Difficulty delivering the baby's shoulder after the head has already come out (called shoulder dystocia)

How to know if a baby has brachial plexus palsy?

When a newborn has brachial plexus injury they may experience:

• Muscle weakness or paralysis in the affected arm or hand.
• Decreased movement or sensation in the upper extremity.

Diagnosis

1. X-rays.
2. nerve conduction study (NCS) and electromyogram (EMG) to test nerve and muscle function.
3. computed tomography (CT or CAT scan)
4. magnetic resonance imaging (MRI)

Management

Most babies with a brachial plexus injury regain both movement and feeling in the affected arm. In mild cases, this might happen without treatment. Other babies might need daily physical therapy. A physical therapist will show parents exercises to do at home to help their baby get better.

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