Birth injuries to newborn babies-management and prognosis
Though child birth is a normal process and majority of newborn babies do not sustain any injury during delivery, birth injuries are occasionally seen especially in a big baby. Serious forms of birth injuries are rarely seen today due to improved obstetric care. Some injuries are self limited and do not need any treatment while others may need some kind of intervention. Some swelling over the presenting part is common. There may be a few small hemorrhages due rupture of minute blood vessels due to pressure. The face may be swollen and have bluish spots due to subcutaneous bleeding when face is the presenting part (normally the caput is the presenting part). Swelling of the eye lids may be marked. The swelling gradually subsides on its own. Cut wounds: During delivery by caesarean the baby may sustains cuts accidentally. If the wound is superficial local applications of an antibacterial cream may suffice. If the wound is deep suturing may be required. Fracture of clavicle: This is the most common type of fracture seen in newborn babies. It occurs when there is some difficulty in delivering the shoulders. The affected baby may not move the arm on the side of the fracture and cries when the collar bone is gently pressed. The Moro reflex will be asymmetrical. After a few days a swelling will be noticed on the bone. Treatment consists of immobilizing the upper limb on the affected side by strapping the limb to the trunk. The fracture heals within a few weeks without any problem. Facial nerve palsy: The facial nerve may be paralyzed due to pressure during birth. It is more common after forceps delivery but can occur during normal delivery. The facial nerve is one of the cranial nerves, which supplies the muscles of the face. When it is paralyzed the baby will not be able to close the eye on the affected side. When the baby cries the angle of the mouth is drawn to the opposite side by the normally functioning muscles of that side. The condition usually resolves by itself. Cephalhemotoma and skull fracture: Bleeding can occur into the scalp due to pressure on the head during birth. A swelling is seen on the scalp which has sharp borders. The hematoma usually subsides on its own. Sometimes it can aggravate jaundice if it is large. Fracture of a skull bone can occur rarely and usually occurs in the bone underlying the cephalhematoma. If it is causing pressure on the brain it may require surgery to elevate the depressed bone. Otherwise the fracture heads with out any treatment. Subgaleal hemorrhage: This is rare but very serious and potentially fatal condition. Bleeding is due to rupture of some veins leading to collection of blood between the skull bones and a sheet like structure beneath the skin of the scalp. This potential space can hold significant amount of blood and hence lot of blood can be lost leading to shock and even death. Immediate blood transfusion is required to save the baby. This is usually due to difficult delivery and repeated use of vacuum extraction. Erb’s palsy: Results from injury to brachial plexus (the brachial plexus is a network of nerves located behind the collar bone). The affected upper limb is kept extended at elbow and internally rotated at shoulder joint. Treatment consists of keeping the arm at right angle to the trunk and elbow bent at right angle. Prognosis is generally good unless there is avulsion of a nerve. Klumpke’s palsy: This is due to injury to lower brachial plexus. The conditions causes wrist drop (inability to extend the wrist). Usually there is complete recovery.
Sternomastoid tumor:A swelling over side of neck is seen a few days after birth. The baby keeps the head turned to the side of swelling. It is not a tumor in the real sense of the term. It is supposed to be due injury to the sternomastoid muscle. Treatment consists of gently stretching the muscle daily till the neck tilt is corrected.
Page last reviewed on 14th November 2009
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