Birth Injuries

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NICU guide

- Birth Injuries

Birth injuries are those that occur to the newborn during the birth process and include:

• Head injuries
• Neck and shoulder injuries
• Internal abdominal organ injuries

- Head Injuries

Scalp Swelling (Caput Succedaneum)

Caput succedaneum is a swelling (fluid accumulation) in the presenting part of the scalp during head-first deliveries. It occurs due to pressure from the uterus or birth canal on the baby's head during delivery.

Causes:

• Large fetal size.
• Disproportion between the fetal head and the mother’s pelvis, leading to prolonged head engagement.
• Difficult labor and the use of delivery instruments (forceps or vacuum extraction).

Symptoms:

• A soft, swollen area on the scalp that crosses the skull's suture lines, appearing immediately after birth.

Nurse’s Role:

• Explain the cause of the swelling and reassure the parents.
• Monitor the swelling, which usually resolves within a few days without intervention.

Subgaleal Hematoma (Cephalhematoma)

Cephalhematoma is a blood collection under the last layer of the scalp, directly above the skull bones, caused by the rupture of blood vessels due to difficult labor.

Symptoms:

• A raised area under the scalp that does not cross the suture lines, appearing hours to days after birth.

Treatment:

• The hematoma typically resolves on its own within two weeks to three months.
• Blood transfusion may be needed in cases of severe anemia or shock.
• If jaundice develops, phototherapy or an exchange transfusion may be required, depending on bilirubin levels.

Nurse’s Role:

• Explain the condition to the parents and reassure them.
• Measure and document head circumference daily.
• Notify the doctor immediately if the newborn shows paleness, jaundice, or an increase in head circumference.

Important Note: Never attempt to aspirate or drain the hematoma, as it could lead to septicemia (blood infection).

Intracranial Hemorrhage (Brain Bleeding)

Intracranial hemorrhage occurs in 20-40% of preterm infants weighing less than 1500 grams, while its incidence is lower in full-term babies.

Symptoms:

• Shock symptoms (significant blood loss).
• Pallor.
• Respiratory distress.
• Jaundice.
• Signs of neurological dysfunction.
• Bulging anterior fontanelle.
• Muscle weakness.
• Seizures.
• Unstable body temperature.
• Apnea (breathing pauses).

Required Tests and Investigations:

• Bleeding and clotting time, hemoglobin levels.
• Cranial ultrasound.
• CT scan of the brain.

Nurse’s Role:

• Avoid unnecessary movement of the newborn.
• Administer intravenous fluids and blood products (albumin, plasma, or whole blood) as per the doctor’s instructions.
• Provide vitamin K and plasma if coagulation abnormalities are detected.
• Monitor and manage jaundice with phototherapy if needed.
• Observe for seizures and report them immediately to the physician.

- Neck and Shoulder Injuries

Clavicle Fracture

A clavicle fracture occurs due to forceful pulling of the baby’s arm or shoulder during delivery, whether the head or breech is delivered first.

Symptoms:

• The newborn is unable to move the affected arm.
• Pain when the arm is touched or moved.
• A cracking sound (crepitus) at the fracture site.
• Absence of the Moro reflex on the affected side.
• Formation of a bone callus at the fracture site between days 7-10.

Nurse’s Role:

• Request an X-ray for diagnosis.
• Immobilize and prevent movement of the affected arm and shoulder for 7-10 days.

Brachial Plexus Injury (Erb’s Palsy)

This condition involves paralysis of the upper limb muscles, resulting from a brachial plexus nerve injury during birth. It may also affect the diaphragm, as it shares the same nerve supply from the 5th and 6th cervical vertebrae.

Symptoms:

• The affected newborn is usually large and may have experienced birth asphyxia.
• The affected arm lies limply at the baby’s side and cannot be raised, flexed at the elbow, or rotated outward.
• The arm takes a characteristic posture:
• Shoulder is lowered.
• Arm is rotated inward.
• Elbow is extended.
• Wrist is flexed, with the hand turned inward and backward.
• Breathing difficulties may appear due to diaphragm paralysis.

Nurse’s Role:

• Immobilize the affected arm for one to two weeks, keeping it in a position opposite to the affected posture.
• Call a specialist for physiotherapy sessions after two weeks, continuing for up to three months to maintain muscle and joint flexibility.

       Erb’s Palsy

- Injury to Internal Abdominal Organs

This refers to injuries affecting internal abdominal organs during birth, including rupture and bleeding in the liver, spleen, or adrenal glands due to pressure or trauma during delivery.

Symptoms:

• Inability to feed.
• Increased heart rate and breathing rate due to internal blood loss.
• Pale or yellowish skin, with sudden signs of shock and abdominal distension.
• Elevated bilirubin levels in the blood due to the breakdown of accumulated red blood cells at the injury site.

Required Tests and Examinations:

• Measurement of bleeding and clotting time and hemoglobin levels.
• Ultrasound examination of the abdomen to detect internal bleeding.
• CT scan of the abdomen to assess the extent of the injury.

Nursing Role:

• Gathering information about the delivery conditions that may have caused the injury.
• Accompanying the newborn for an ultrasound scan of the abdomen.

- Hip Dislocation (Developmental Dysplasia of the Hip – DDH)

Clinical Presentation:

• More common in newborn females and in cases of breech presentation.
• Diagnosis is usually made through routine screening tests performed by the physician on every newborn immediately after birth, aiming for early detection and management.
• If hip dislocation is suspected, confirmatory imaging (X-ray and ultrasound) is performed to evaluate the joint.

Nursing Care:

• Maintain abduction of the hips by applying double diapers (one over the other) until the infant is referred to an orthopedic specialist for possible surgical intervention.