Birth Injuries

Birth Injuries: Scalp Swellings & Risk Factors - Head Start Hurdles

• General Risk Factors: Macrosomia, malpresentation, operative delivery (forceps/vacuum), shoulder dystocia, precipitous labor.

📌 Mnemonic: Caput Crosses sutures. Hematoma Hesitates (at sutures). Subgaleal Spreads widely.

⭐ Subgaleal hemorrhage is the most dangerous neonatal scalp injury due to its potential for massive blood loss and hypovolemic shock.

Birth Injuries: Nerve Palsies - Delivery Nerve Drama

• Brachial Plexus Palsy (BPP): Brachial plexus nerve injury during delivery.

  ⭐ Erb's palsy (C5-C6) is the most common BPP in newborns.

  • Types:

    Feature	Erb-Duchenne Palsy	Klumpke's Palsy
    Nerve Roots	C5-C6 📌 'पकड़ने में ERror, Bazu (arm) बेकार'	C8-T1
    Presentation	'Waiter's tip': adducted, int. rotated arm, extended elbow, flexed wrist	'Claw hand'
    Reflexes	Absent Moro/biceps (affected side)	Absent grasp reflex
    Associated	-	Horner's (ptosis, miosis, anhydrosis)

  

• Facial Nerve Palsy (CN VII):

  • Cause: CN VII compression.
  • Signs: Asymmetric crying facies (mouth to normal side, poor eye closure affected side).
  • Prognosis: Often spontaneous resolution.

• Phrenic Nerve Palsy (C3, C4, C5):

  • Cause: Phrenic nerve injury.
  • Signs: Diaphragmatic paralysis, respiratory distress, ↓ breath sounds (affected side).
  • Mgmt: Ventilatory support if severe.

Birth Injuries: Bone Breaks & Muscle Strains - Skeletal Snaps

• Clavicular Fracture: Most common birth fracture, often mid-clavicle.
  • Signs: Crepitus, palpable bony irregularity, asymmetric Moro reflex, infant irritable on handling.
  • Management: Gentle handling, immobilize arm (pin sleeve to chest). Heals rapidly with callus.

  ⭐ The clavicle is the most frequently fractured bone during labor and delivery, often presenting with an absent Moro reflex on the affected side.

• Humeral Fracture: Usually shaft; from traction.
  • Signs: Pain, crepitus, deformity, ↓ arm movement.
  • ⚠️ Risk of radial nerve injury.
• Femoral Fracture: Rare; requires significant force.
  • Signs: Deformity, swelling, pain on leg movement.
• Sternocleidomastoid Injury (Congenital Muscular Torticollis): SCM muscle hematoma/fibrosis.
  • Head tilted to affected side, chin to opposite. Palpable 'tumor' in SCM.

Birth Injuries: Internal Organ Injuries - Visceral Vulnerabilities

• Liver Injury/Subcapsular Hematoma:
  • 2nd most common abdominal injury.
  • Risks: Macrosomia, breech, hepatomegaly.
  • Signs: Anemia, shock, distension; rupture → hemoperitoneum.
• Splenic Rupture:
  • Less common. Risks/presentation similar to liver (shock, anemia).
• Adrenal Hemorrhage:
  • Common. Risks: Hypoxia, stress, trauma.
  • Signs: Often asymptomatic; or mass, jaundice, anemia. Rarely adrenal insufficiency. Ultrasound aids diagnosis.
• Intracranial Hemorrhage (Traumatic):
  • Subdural (SDH): Dural sinus/venous tears.
  • Subarachnoid (SAH): Often asymptomatic/mild irritability. (Distinct from HIE-IVH).

⭐ Adrenal hemorrhage in a newborn can present with an abdominal mass, persistent jaundice, and anemia; it is often detected on ultrasound.

High‑Yield Points - ⚡ Biggest Takeaways

• Caput succedaneum crosses suture lines; cephalohematoma doesn't, is subperiosteal.
• Erb's palsy (C5-C6) causes waiter's tip deformity; Klumpke's palsy (C8-T1) causes claw hand ± Horner's syndrome.
• Clavicular fracture is the most common neonatal bony injury; presents with crepitus, asymmetric Moro reflex.
• Facial nerve palsy leads to asymmetric crying facies, often associated with forceps delivery.
• Subarachnoid hemorrhage is the most common type of neonatal intracranial bleed; subdural bleeds are often from tentorial tears.
• Phrenic nerve palsy (C3-C5) results in respiratory distress and unilateral diaphragmatic elevation on X-ray.