Birth Injuries

Hypoxic-Ischaemic Encephalopathy (HIE)

This refers to injury to the brain, which is caused by being deprived of oxygen, due to a significant hypoxic event immediately before or during delivery

– Damage occurs immediately from primary neural death and after due to reperfusion injury

Causes:

Anything which decreases oxygen transfer across placenta or oxygenation of blood after birth

Symptoms:

– Reduced level of consciousness

– Reduced muscle tone and reflexes

– Seizures

– Inability to feed

– Respiratory distress with difficulty in maintaining adequate respiration

Tests:

– Umbilical cord blood gas analysis –> shows perinatal hypoxia

– MRI/CT –> shows neonatal encephalopathy

Management:

– Hypothermia (wrap infant in a cooling mattress)

– Aim to decrease rectal temperature to 33-34 degrees

– This reduces brain damage, reduces future disability, and improves survival rates

Soft-tissue injuries

These encompass a range of injuries that babies can experience during delivery

– They are often due to mechanical trauma caused by the scalp pushing through the cervix in a difficult delivery

– They can also occur secondary to the use of instruments in an assisted delivery.

Caput Succedaneum

This is a condition which describe the presence of a subcutaneous collection of fluid (oedema) external to the galea aponeurosis at the presenting part of the head.

– This is present immediately after or within a few hours of birth but there is no damage to the brain or the skull

Symptoms:

– Soft swelling that looks like a bump at the tip of the baby’s head

– Has indistinct margins and crosses suture lines

Management:

No treatment is needed as resolves within days

Subgaleal Haematoma

This refers to a bleed between the potential space between the galea aponeurosis and the periosteum

– Most of these cases are due to a ventouse-assisted delivery as the vacuum ruptures the small venous connections between the scalp veins and dural venous sinuses.

Symptoms:

– Fluctuant boggy swelling over the scalp (especially occipital area) which develops hours/days after delivery

– Bruising over the skin

– Can lead to haemorrhagic shock and jaundiced due to haemolysis of blood.

Management:

– Manage with ABCDE approach

– Manage haemorrhagic shock loss with fluid challenge and transfusion

– Manage jaundice with phototherapy

Cephalohematoma

This is bleeding between the periosteum and the bone, usually over parietal area

– This usually develops several hours after birth

– As the swelling is subperiosteal, it does not cross suture lines

Symptoms:

– Haematoma that forms a swelling and feels soft

– It does not cross suture lines

– If severe can develop jaundice, anaemia, or hypotension 

Management:

Conservative treatment only but can up to 3 months to resolve