This document discusses various types of birth injuries including caput succedaneum, cephalohematoma, subarachnoid hemorrhage, intraventricular hemorrhage, skull fractures, brachial plexus injuries (Erb's palsy), facial nerve palsy, and spinal cord injuries. It describes the causes, signs, symptoms, diagnosis, and treatment for each condition. Complications from difficult births can cause damage due to pressure or stretching of nerves and blood vessels in the head or neck. Imaging tests help diagnose injuries while most cases are managed with close monitoring, protection of injured areas, and physical therapy.

1. BURTH INJURIES
PRESENTED BY-
JAYESH SONI
HOD - CHILD HEALTH NURSING
VENKTESHWAR COLLEGE OF NSG
UDAIPUR

9. • “Caput succedaneum” refers to
swelling or edema of an infant’s scalp
that appears as a lump or bump on
their head shortly after delivery.
• This condition is harmless and is due to
pressure put on the infant’s head
during delivery. It doesn’t indicate
damage to the brain or the bones of
the cranium.
• It’s a serosanguinous fluid collection
above the periosteum.
• It present as a soft tissue swelling with
purpura & ecchymosis over the
presenting portion of scalp.

10. • The edema, molding of head & overriding of parietal
bones disappear during 1st week of life.
• The main symptom of caput succedaneum is puffiness
under the skin of the scalp.
• The skin is swollen and soft.
• Pressing on it may result in a dimple in the flesh.
• The swelling may be on one side or may extend over
the midline of the scalp.
• There may be some discoloration or bruising, but this
isn’t as extensive as in cephalohematoma.
• The swelling and bruising may increase the risk
of infant jaundice, which is yellowing of the skin due to
excess bilirubin in the blood, But clear up without
treatment within 2 to 3 weeks

13. • Cephalhematoma is a subperiosteal blood
collection caused by rupture of vessels beneath
the periostenum

25. Subarachnoid Hemorrhage
A subarachnoid hemorrhage is one of the most common types
of intracranial hemorrhage (brain bleed), and is characterized by the
pooling of blood between the arachnoid and the pia mater.
CAUSES:
In newborns, subarachnoid hemorrhages can result from
either birth trauma (excessive mechanical force on the baby during
birth) or hypoxic-ischemic injury (lack of oxygenated blood flow to
the brain)
Birth trauma include -
mismanagement of an abnormal fetal
presentation & Improper use
of forceps or vacuum extractors.

26. Signs of a subarachnoid hemorrhage may include:
• Seizures
• Apnea: temporarily ceasing to breathe
• Bradycardia: slow heart rate
• Hydrocephalus: a condition in which fluid builds up in the brain; about
20-30% of infants with subarachnoid hemorrhage develop
hydrocephalus
• Hyperestesia: increase physical sensitivity
Diagnosed with a CT scan, MRI, Monitoring neurological signs and
seizures
Managing seizures, Administering intravenous therapy, and preventing
further hemorrhage, Some may require surgical intervention, such as
the insertion of a shunt to treat hydrocephalus

27. Intraventricular Hemorrhage

28. • An intraventricular hemorrhage (IVH) is a serious type of
infant brain bleed that occurs when there is bleeding within the
brain’s ventricular system. It usually takes place in an area called the
germinal matrix, which holds many important cells in a developing
brain.
• The ventricular system is where spinal fluid is produced.
Intraventricular hemorrhages can result from hypoxia (oxygen
deprivation) or from physical trauma during
birth. Premature and low birth weight
• Improper management of birth and neonatal care can result in
intraventricular hemorrhages

29. Risk factors and causes of Intraventricular hemorrhages
• Intraventricular hemorrhages (IVH) occurs in babies who are
born at less than 32 weeks of gestation or have a birth weight
of less than 1500 grams and are not properly managed
• Other risk factors for IVH include hypoxic-ischemic
encephalopathy (HIE) (brain damage caused by insufficient
oxygenated blood flow during or near the time of birth) &
birth trauma.
• Traumatic head injury can also
result in ruptured blood vessels.
Head trauma is often caused by the
use of forceps and vacuum
extractors. excessive pressure or
misuse these devices, resulting in a
brain bleed.

30. Signs of intraventricular hemorrhages-
• The baby is weak, decreased movement
• Breathing is abnormal or irregular breathing or sometimes stop
breathing (apnea)
• Changes in eye positioning and movement, decreased reflexes
• The baby has pale or blue coloring
• Present seizures, Coma or stupor (state of being nearly
unconscious)
• The baby’s heart rate is slow and/or their blood pressure is low
• The baby has high-pitched crying
• Bulging anterior fontanel
• Bradycardia & Hypotension

31. Diagnosis and treatment of intraventricular hemorrhages
Intraventricular hemorrhages are diagnosed with a head (cranial)
ultrasound. Physicians use the ultrasound to determine the location and
extent of the IVH.
Grading of the severity of the IVH is as follows:
• Grade I IVH – Bleeding is confined to the germinal matrix, which is very
important in brain development.
• Grade II IVH – Bleeding is occurring inside the ventricles.
• Grade III IVH – Bleeding has caused the ventricles to become enlarged and
press on the brain tissue.
• Grade IV IVH – Bleeding extends into the brain tissue around the ventricles,
which is also called an intraparenchymal hemorrhage.
IVH is generally managed by:
• Providing necessary fluid, nutrition, and metabolic support
• Providing adequate ventilation and oxygenation
• Maintaining arterial perfusion to preserve blood flow to the brain
• Monitoring for post-hemorrhagic ventricular dilation (PHVD) or
hydrocephalus
• Treating seizures to avoid further damage

32. SKULL FRACTURE
Babies are born with skulls that are soft and flexible which
allows babies to fit through the birth canal with less risk of damage
to the bone but also allows for growth as child ages. The infant skull
is made up of several plates held together by sutures. The sutures are
fibrous and flexible and allow the plates to move and the skull to
expand with growth.
Although the skull of an infant helps to come out during
vaginal delivery with a lower risk of harm and injury, but it is still
vulnerable. It is more vulnerable to fracture and resulting damage to
the brain than the skull of an older child or an adult.
Fracture of the vault of the skull (frontal bone or anterior part
of the parietal bone) is defined as distortion in the continuity of skull
bone which may be of fissure/linear or depressed type.

33. A linear fracture is a simple split in the bone, but it does not lead to
movement between the plates of the skull.
A depressed skull fracture occurs with an injury that causes an
indentation in the skull.
DEPRESSED SKULL FRACTURE

35. • Causes
• Effect of difficult forceps delivery or due to wrong application of
forceps.
• Projected sacral promontory of the flat pelvis
• Clinical Features
• Fissure/linear fracture, if uncomplicated is usually
symptomless.
• Depressed fracture may be associated with neurological
manifestations.
• Signs of associated complications such as intracranial
hemorrhage, raised intracranial pressure, leakage of CSF.
• Diagnosis
• History of type of delivery, other injuries to head during
birth.
• Physical examination
• X-ray can confirm diagnosis.

36. • Management
• Linear or fissure fracture requires no treatment.
• Depressed fracture may require surgical elevation.
• If there is leakage of cerebral fluid through nose, antibiotic
therapy is indicated.

37. PERIPHERAL NERVOUS SYSTEM
• The peripheral nervous system is a network of 43 pairs of
motor and sensory nerves that connect the brain and spinal
cord (the central nervous system) to the entire human body.
• These nerves control the functions of sensation, movement
and motor coordination.

39. BRACHIAL PLEXUS
• The brachial plexus is an arrangement of nerve fibres, running
from the spine, formed by ventral rami of lower cervical and
upper thoracic nerve roots includes – from above the fifth
cervical vertebra to underneath the first thoracic vertebra(C5-
T1). It proceeds through neck, axilla and into the arm. It is
responsible for cutaneous and muscular innervation of entire
upper limb.

40. BRACHIAL PLEXUS INJURY
Erb's palsy or Erb–Duchenne palsy is a form of obstetric
brachial plexus palsy. It occurs when there's an injury to the brachial
plexus, specifically the upper brachial plexus at birth.
The injury can either stretch, rupture or avulse the roots of the
plexus from the spinal cord.
It is a lesion of C5 & C6 nerve roots (in some cases C7 is
involved as well) usually produced by widening of the head
shoulder interval. Injuries to the brachial plexus affects movement
and cutaneous sensations in the upper limb.
The Erb's point is a site at the upper trunk of the Brachial
Plexus located 2-3cm above the clavicle. It's formed by the union of
the C5 and C6 roots. Affected nerves in Erb's palsy are the axillary
nerve, musculocutaneous, & suprascapular nerve.
• Axillary nerve- originates from the terminal branch of posterior
cord receiving fibers from C5 and C6.
• Musculocutaneous nerve- originates from the terminal branch of
lateral cord receiving fibers from C5-C7.
• Suprascapular nerve- originates from the superior trunk receiving
fibers from C5, C6 often C4.

42. CAUSES- The most common cause of Erb's palsy is excessive
lateral traction or stretching of the baby's head and neck in
opposite directions during delivery usually associated with
shoulder dystocia (Slow dilation of the cervix or descent of the fetus during active
labor).
Pulling on the infant's shoulder during delivery or
excessive pressure on the baby's raised arm during a breech
delivery can cause brachial plexus injury.
SYMPTOMS- injury includes lack of reflexes on the affected
side, no movement in the arm or a part of the arm, minimal
grip strength in the affected hand, and an arm bent at the elbow
and held tightly to the side of the infant. child may also
experience weakness, loss of feeling, or partial or total
paralysis in the arm.

43. The classical sign of erb's palsy is called Waiter's tip deformity.
This is due to loss of the lateral rotators of the shoulder, arm
flexors, and hand extensor muscles.
Diagnosis-
History- pregnancy complication either
by gestational diabetes or maternal
obesity, prolonged second stage labour,
shoulder dystocia, use of assistive
techniques-forceps to aid delivery.
Physical examination- most often shows
decreased or absent movement of the
affected arm.
Neurologic examination- assesses muscle
power, sensation,reflexes- moro reflex is
absent on the affected arm.
MRI of the shoulder

44. TREATMENT- For most children born with Erb’s palsy,
recovery occurs within three to six months. The recovery of
damaged nerves is slow but possible for many infants. Most
children with this condition will receive physical therapy to
help stimulate healing and to prevent permanent stiffness in
the joints of the arm.
• In more severe cases of Erb’s palsy, surgical treatments may be
necessary.
• For torn nerves, a graft using a donor’s nerve may be possible
and can restore feeling and movement.
• A full replacement of a nerve with a donor’s nerve may also
work, but these are complicated surgeries and they are not
always successful at restoring complete movement and
sensation.
• Nerve surgery is not done until the infant is at least six months
if the nerves are not healing.

46. FACIAL NERVE PALSY
Facial nerve palsy due to birth trauma is the loss of
controllable (voluntary) muscle movement in an infant's face due to
pressure on the facial nerve just before or at the time of birth.
CAUSES-
• An infant's facial nerve is also called the seventh cranial nerve. It
can be damaged just before or at the time of delivery.
• Most of the time the cause is unknown. But a difficult delivery, with
or without the use of an instrument called forceps, may lead to this
condition.
• Some factors that can cause birth trauma (injury) include:
– Large baby size (may be seen if the mother has diabetes)
– Long pregnancy or labor
– Use of epidural anesthesia
– Use of a medicine to cause labor and stronger contractions

47. SYMPTOMS-
• The most common form of facial nerve palsy due
to birth trauma involves only the lower part of
the facial nerve. This part controls the muscles
around the lips. The muscle weakness is mainly
noticeable when the infant cries.
• The newborn infant may have the following
symptoms:
– Eyelid may not close on affected side
– Lower face (below eyes) appears uneven during crying
– Mouth does not move down the same way on both
sides while crying
– No movement (paralysis) on the affected side of the
face (from the forehead to the chin in severe cases)

48. Exams and Tests
A physical exam is usually all that is needed to diagnose
this condition. In rare cases, a nerve conduction test is
needed. This test can pinpoint the exact location of the nerve
injury.

49. Treatment
 In most cases, the infant will be closely monitored to see
if the paralysis goes away on its own.
 If the baby's eye does not close all the way, an eyepad
and eye drops will be used to protect the eye.
 Surgery may be needed to relieve pressure on the nerve.
 Infants with permanent paralysis need special therapy.

51. SPINAL CORD INJURY
The spinal cord is a bundle of nerves responsible for carrying
messages between the brain and the rest of the body.
Damage to the spinal cord interferes with this connection.
This results in temporary or permanent changes to muscle
function and sensation.
Spinal cord injuries affecting the neck are known as cervical
injuries. They can result in quadriplegia, or a total loss of
control over all four limbs and the torso. Damage near the
very top of the spinal cord can be fatal. Lower damage may
only affect the child’s legs.

52. • A complete spinal cord injury occurs when the spinal cord is
fully severed or compressed, resulting in the loss of all
movement and sensation below damaged area. There is still a
potential for some level of recovery.
• An incomplete spinal cord injury occurs when the spinal cord
is damaged but still able to transmit signals below the site of
injury. Incomplete spinal cord injuries allow the patient to
maintain some sensation and movement.

53. CAUSES:

54. Spinal Cord Injury Signs and Symptoms
Most signs of a spinal cord injury will be visible
immediately. In 25% of cases, it can take 30 minutes to 4 days
for symptoms to fully appear.
• Loss of muscle function in some or all of the limbs
• Baby seems floppy when picked up
• Loss of sensation in the body or lack of reflexes
• Breathing problems
• Spasms
• Loss of bowel and bladder function
Diagnosis with-
X-rays- locate vertebral fracture who damage nerves of spine
MRI’s- can reveal nerve compression, tumors on the spine and
lesions in the spinal cord.
CT Scans

55. TREATMENT
Treatment for spinal cord injury involves a team of medical
professionals and therapists who work with child as they
develop.
They administer medication, such as corticosteroids, to decrease
swelling and stabilize the injury.
Recommend surgery to examine the damage or release pressure
on injured nerves.
Depending on the severity, treatment may include a breathing
machine, a feeding tube and a bladder catheter.