Birth injuries and Trauma definition and facts

Birth Injuries and Trauma: definition, classification and causes

 

Definition of  Birth Trauma/ Injury

Birth trauma is a general term used to describe any cuts, fractures, or other injuries sustained by a newborn baby during labor or delivery.

Classification of Birth Injuries

photo extracted from Wong's nursing care of infants and children/ edited by Hockenberry and Wilson.




 Books that have information on birth injuries  in our Mpilo Library collection
1. Illustrated textbook of paediatrics by T Lissauer & G Clayden
2. Wong's Nursing care of infants and children by Hockenberry and Wilson
3. Forfar & Arneil's Textbook of pediatrics edited N McIntosh et al P Helms, R Smyth
4. Maternity & Women's Health Care by Lowdermilk
5. Pediatrics and Children Health: A manual for health professionals in the third world edited by H M Coovadia and D F Wittenberg
6. Essential paediatrics edited by d |Hull 
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Predisposing factors for birth Injury or trauma

-occurs more frequently among larger-than-average babies, especially if baby’s size may be too large in relation to the mother’s pelvic area.
Such require nurses and doctors to use their hands, forceps, or vacuums to ease their passage through the birth canal.
- neonatal injuries can occur if a nurse or doctor uses too much physical force while handling the baby or is not careful with birthing instruments.
 the most common conditions that cause birth trauma include:
  •        Babies that weigh over 8 pounds, 13 ounces (4,000 grams)
  •        Babies born before the 37th week of pregnancy
  •        The mother’s pelvis may have the wrong shape or size for a safe delivery
  •        Difficult labor or delivery (dystocia)
  •        Prolonged labor
  •        Abnormal fetal position at birth (baby is in a head-up, buttocks-first, or breech, position)
  extracted from http://www.birthinjuryguide.org/birth-injury/types/birth-trauma/

A study on birth injuries

A study conducted by Levine, Holroyde, Wood, Siddiqi, Scott, and Miodovnik, (1984) found that there were certain incidence and predisposing factors likely to lead to birth trauma. The authors found through logistic regression analysis of fetal, maternal, and intrapartum complications in labor and delivery revealed that midforceps , shoulder dystocia, low forceps, infants greater than 3500 g, and second stage labor exceeding 60 minutes were the predominant events associated with fetal injury. The authors then applied a risk assessment profile to successfully identify over 50% of the injured and 84% of the uninjured groups. From their results, the authors suggest that obstetricians should alert the pediatricians when these predisposing factors exist to aid in the recognition and early treatment of these birth injuries.

extracted from https://www.ncbi.nlm.nih.gov/pubmed/6728359

Illustration of Birth Injuries

 
Photo from Essential Paediatrics By Hull and Johnston

 

Common Birth-Related Traumas

most common neonatal injuries affect a baby’s head, neck, and shoulders, but can occur any part of body . These areas of the body are more likely to be injured because most babies are born in a head-first position.
 the most common traumatic injuries include:

Caput Succedaneum

-marked by scalp swelling, typically during or shortly after birth.
-caused by pressure from the mother’s uterus or vaginal wall during delivery.
Bruising of the scalp is more likely to occur during a long and difficult labour,
- iwhen the amniotic sac has broken and the baby’s head is unprotected while passing through the birth canal
- use of vacuum extraction devices during a protracted delivery.

Cephalohematoma

- is an accumulation of blood below the baby’s periosteum, the protective membrane that covers an infant’s skull.
identified as lumps on baby’s head, several hours after delivery.
-lumps feel soft and may grow larger during the baby’s first hours postpartum.
-Might not require medical attention and disappear within a few weeks or months as the body reabsorbs the blood.
-some cephalohematomas may cause jaundice if they are too large and too many red blood cells break down.

Bruising and Broken Bones 

Bruising occur on a baby’s face, head, and/or other body parts
can be due to - physical stresses of the passage through the birth canal or contact with bones and tissue in the mother’s pelvis. -use of forceps during delivery which marks the newborn’s head or face, especially when doctors use too much force.
-vacuum extraction may cause lacerations or bruising on a baby’s scalp.

- broken bones can occur  when birth-assisting tools are not used well or with exceesive force or when its pulled with too much force. In extremely rare instances, a physician or someone on the medical staff may drop a newborn.

Subconjunctival Hemorrhage

can be defined as bleeding that occurs when small blood vessels in the baby’s eyes break.
-can be in one or both eyes
-eyes havea bright red band around the iris
disappears after some days once body reabsorbs the blood.

Bell’s Palsy 

- occurs when a baby’s facial nerve is damaged during labor or birth. In most cases, nerve damage is caused by pressure on the infant’s face during the passage through the birth canal.However, facial paralysis can be also caused by doctors that use forceps during delivery
Nerve damage is most noticeable when babies cry. The facial muscles on the side where the nerve was injured can’t move, and the eye on that side remains open.
Bell’s palsy eventually improves without treatment if the nerve is only bruised. If the baby’s facial nerve is torn, surgery may be needed to restore muscular function on the affected area.

Brachial Plexus Injury

A brachial plexus injury is the result of an injury to a baby’s brachial plexus. This is a network of nerves that connects the spinal cord to the baby’s arms and hands. Brachial palsy is a common occurrence in difficult births, especially if a baby’s shoulder gets stuck in the birth canal and a doctor tugs hard on one arm to help extract the newborn.
The most common sign of brachial palsy is when a baby can’t flex or rotate the affected arm. The severity of the injury depends on how badly damaged the nerves are. If the nerves are only bruised or stretched, the injury heals over a period of weeks or months and arm movement is restored with the aid of physical therapy.
More serious injuries, in which the nerves are torn, often result in permanent nerve damage.

Oxygen Deprivation

Oxygen deprivation, or anoxia, before or during birth can cause serious health problems to a newborn. This type of birth of trauma can occur if the placenta separates prematurely or if the umbilical cord becomes entangled around the baby’s neck and reduces oxygen flow to the brain.
Inadequate oxygen supply often causes damage to a baby’s cerebellum, the part of the brain that controls the body motor functions. This results in the onset of cerebral palsy (CP), a group of neuromuscular disabilities that affect a child’s ability to control movement, posture, and muscle tone.
Oxygen deprivation can also occur if a baby doesn’t start breathing independently after birth. Delays in breathing that last for 3 minutes or more are a high risk factor of serious brain damage. This category of birth injury destroys brain cells within a matter of minutes and causes seizures, coma, and, if a baby is not placed in life support in time, death.
Oxygen deprivation causes permanent disabilities like cerebral palsy, and is also a major cause of hearing impairment, partial or total blindness, learning disabilities, and other complications.
Hypoxia is a slightly less severe form of oxygen-related birth trauma. Unlike anoxia, which is used to describe total oxygen deprivation, hypoxia refers to low levels of oxygen in a baby’s circulatory system.

Fractures

Fractures are the most common injuries associated with birth trauma. Fractures generally affect a baby’s clavicle (collarbone) and are frequently caused by shoulder dystocia or during breech deliveries. This type of injury prevents a baby from moving the arm on the affected side. If the infant feels pain as a result of the fracture, a splint or soft bandage is needed to prevent jostling of the arm until the injury heals.
Most birth traumas are conditions that usually heal on their own without any medical treatment. Babies often recover with few or no complications, although individual outcomes depend on a wide range of factors, such as the severity and cause of the injuries.
In many instances, birth trauma can be avoided if doctors recognize and foresee medical risk factors. Proactive measures, such as monitoring the mother’s health or using ultrasound images to check the fetus’ position in the weeks and days before labor, often prevent help birth trauma and injuries

Most of information above has been extracted from http://www.birthinjuryguide.org/birth-injury/types/birth-trauma/

Infant Cystic Fibrosis | Birth Injury Guide

Cystic Fibrosis, a medical condition marked by difficulties in breathing and digestion, that affects around 300,000 people in the United States. Cystic fibrosis can develop at any age, including infant cystic fibrosis whose parent has been diagnosed with the condition and/or carries an affected gene.

What is Cystic Fibrosis?

Sometimes a life-threatening disease, cystic fibrosis is an inherited disorder marked by abnormal glands that produce thicker and more abnormal mucus and sweat. In some cases, the build-up of mucus often resides in the lungs, the digestive tracts, and other areas of the body.
It’s the cystic fibrosis in the lungs that interferes with respiration and sometimes causes life-threatening problems. When an infant has cystic fibrosis, the mucus builds up in the lungs, the pancreas, and the liver, which not only complicate the function of those organs but likewise make the infant prone to infections in those areas.

How is Cystic Fibrosis Life-Threatening?

Not only are the infections in organs such as the liver, lungs, and pancreas dangerous, but most children end up having life-threatening complications from the presence of the mucus in the lungs. As the lungs are one of the last organs to develop in the fetus before birth, and because the fetus doesn’t get practice using the lungs before birth, infants already have a hard time learning to use their lungs.
Yet, when you introduce the challenge of extra mucus in the lungs, the infants have trouble breathing –sometimes the challenge is too much for them. Additionally, the mucus of cystic fibrosis resides in the digestive tract, interfering with the way that newborns process important nutrients.
Often, infants with cystic fibrosis are underweight, have trouble breathing, and have a heightened risk of dying for the condition’s complications.

What is the Cause of Cystic Fibrosis?

Cystic fibrosis is a genetic disease and can only because via a parent  passing down gene changes to the infant.
There is no way to stop cystic fibrosis, aside from diagnosing a parent with the disorder and informing them that it can be passed down. However, there are several instances in which cystic fibrosis may be considered a birth injury, including:
  • Physicians fail to screen the infant for cystic fibrosis, and therefore fail to provide medical treatment
  • A woman receives eggs, sperm, or an embryo that was not screened for cystic fibrosis (wrongful pregnancy)
  • Misread or improperly performed genetic testing prior to pregnancy

What are the Symptoms of Cystic Fibrosis?

If for whatever reason your physician has not diagnosed the baby with cystic fibrosis during pregnancy, there are a number of symptoms that the baby may exhibit, including:
  • Breathlessness
  • Foul-smelling and greasy stool
  • Intestinal blockage
  • Inflamed nasal passages
  • Persistent cough that produces thick spit or mucus
  • Poor weight gain and growth
  • Repeated lung infections
  • Severe constipation
  • Wheezing
  • Salty skin
  • Stomach pain and/or bloating
Keep in mind that not all infants will exhibit every symptom and not all infants will exhibit the same symptoms.

How Do You Treat Cystic Fibrosis?

While there is no cure for cystic fibrosis, there are treatments that can lessen the symptoms and can help the child to live a little more comfortably as long as that is. Treatment may includes:
  • Preventing and controlling lung infections
  • Loosening and removing thick mucus from affected areas
  • Preventing and treating blockages in the digestive tract
  • Providing sufficient nutrition in any way possible, and,
  • Preventing dehydration so that the digestive tract works properly

Long-term Outlook

With proper treatment and nutrition, most babies with cystic fibrosis will go on to grow normally. However, in some instances, children with cystic fibrosis will grow more slowly than other children their age.
In order to promote healthy growth, children with cystic fibrosis are often given special medications, along with high-calorie meals that are loaded with vitamins.
In some cases, children may develop cystic fibrosis-related diabetes, which requires insulin injections prior to mealtime.
extracted from http://www.birthinjuryguide.org/birth-injury/types/infant-cystic-fibrosis/

References

1.  http://www.birthinjuryguide.org/birth-injury/types/infant-cystic-fibrosis/
2.  http://www.birthinjuryguide.org/birth-injury/types/birth-trauma/
3.  Wong's nursing care of infants and children/ edited by Hockenberry and Wilson.
4. Essential pediatrics by Hull and Johnston
4.  http://www.mayoclinic.org/diseases-conditions/subconjunctival-hemorrhage/basics/definition/con-20029242

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