Section VIII: Pediatrics

Conditions

Classification of Birth Injuries

Cerebral Birth Injury

Cerebral birth injury is damage to the nervous system by complications during pregnancy, labor, delivery, or the immediate neonatal period. It is associated with a number of predisposing factors related to maternal health, maternal age, social status, labor and delivery, birth weight, gestation, and parity. The most common mechanisms are asphyxia (which may be chronic or acute) and trauma.

intraventricular hemorrhage—not related to trauma: More common in premature infants and with respiratory distress syndrome.

compression head injury—compression of the head: Most likely in fullterm or postmature infants, many of whom are large for their gestational age. May present as subarachnoid, subdural, or (infrequently) cerebellar hemorrhage.

Fractures

Most of these lesions heal without treatment; however, the infant may be more comfortable when the fracture is immobilized.

skull fractures: Fissure fractures are not uncommon but are usually of little significance. Depressed fractures (a "pond" fracture) may result from pressure on the sacral promontory. The majority resolve spontaneously.

clavicle fractures: This fracture may occur during breech delivery if the baby's arms become displaced or may be the result of a difficult vertex delivery. Recovery is likely without treatment; however, the upper arm may be immobilized against the chest. The baby should always be examined for a concurrent brachial plexus injury.

humeral fractures: This fracture may occur when a displaced arm is pulled down during a breech delivery. The baby should always be examined for nerve damage.

femoral fractures: This fracture may occur when a leg is pulled down during delivery of a breech presentation with extended legs. The fracture may be immobilized by bandaging the affected limb to the abdomen.

Nerve Lesions

abducens palsy: Transient abducens palsy occurs in a significant proportion of children born after prolonged labor and those who are delivered by forceps. Usually there is full recovery after a few days or weeks.

facial palsy: Pressure from a forceps blade may injure the extracranial part of the facial nerve. Facial palsy occasionally occurs following a spontaneous vaginal delivery. Recovery may be expected within 2–3 weeks.

Erb's palsy: Trauma to the C5 and C6 spinal roots due to excessive traction on the neck during a delivery, such as a difficult breech extraction or vertex delivery, where there has been difficulty with delivery of the shoulders. The affected arm lies limply at the infant's side, with the hand pronated and wrist slightly flexed. Recovery is usually complete within 2 weeks.

other brachial plexus injuries: The C4 root may be implicated in addition to Erb's palsy, thereby affecting function of the diaphragm with possible resultant acute respiratory distress. Much less common is damage to ...