Neonatal birth injuries
- Tiffany M McKee-Garrett, MD
Tiffany M McKee-Garrett, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- William Phillips, MD
William Phillips, MD
- Section Editor — Pediatric Orthopedics
- Professor of Pediatrics and Orthopedics
- Baylor College of Medicine
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
Birth injury is defined as an impairment of the neonate's body function or structure due to an adverse event that occurred at birth. The overall incidence of birth injuries has declined with improvements in obstetrical care and prenatal diagnosis. The reported incidence of birth injuries is about 2 and 1.1 percent in singleton vaginal deliveries of fetuses in a cephalic position and in cesarean deliveries, respectively [1,2]. Injury may occur during labor, delivery, or after delivery, especially in neonates who require resuscitation in the delivery room.
There is a wide spectrum of birth injuries ranging from minor and self-limited problems (eg, laceration or bruising) to severe injuries that may result in significant neonatal morbidity or mortality (ie, spinal cord injuries).
The risk factors associated with birth trauma and specific birth injuries will be reviewed here.
The following factors that increase the risk of birth injuries may be due to the fetus (eg, fetal size and presentation), the mother (eg, maternal size and the presence of pelvic anomalies), or the use of obstetrical instrumentation during delivery:
●Macrosomia – When the fetal weight exceeds 4000 g, the incidence of birth injuries rises as the fetal size increases. In one study, when compared with normosmic neonates, the incidence of birth injury was twofold greater in infants weighing 4000 to 4499 g, three times greater in those with births weights between 4500 to 4999 g, and 4.5 times greater in those with a birth weight greater than 5000 g . In another study, the incidence of fetal injury was 7.7 percent in infants with birth weights greater than 4500 g .
- Alexander JM, Leveno KJ, Hauth J, et al. Fetal injury associated with cesarean delivery. Obstet Gynecol 2006; 108:885.
- Demissie K, Rhoads GG, Smulian JC, et al. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis. BMJ 2004; 329:24.
- Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003; 188:1372.
- Nassar AH, Usta IM, Khalil AM, et al. Fetal macrosomia (> or =4500 g): perinatal outcome of 231 cases according to the mode of delivery. J Perinatol 2003; 23:136.
- Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103:219.
- Moczygemba CK, Paramsothy P, Meikle S, et al. Route of delivery and neonatal birth trauma. Am J Obstet Gynecol 2010; 202:361.e1.
- Hughes CA, Harley EH, Milmoe G, et al. Birth trauma in the head and neck. Arch Otolaryngol Head Neck Surg 1999; 125:193.
- Rosenberg A. Traumatic birth injury. NeoReviews 2003; 4:270.
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114:297.
- Dessole S, Cosmi E, Balata A, et al. Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital. Am J Obstet Gynecol 2004; 191:1673.
- Siegel DH, Holland K, Phillips RJ, et al. Erosive pustular dermatosis of the scalp after perinatal scalp injury. Pediatr Dermatol 2006; 23:533.
- Anshelevich A, Osterhoudt KC, Introcaso CE, Treat JR. Picture of the month--quiz case. Halo scalp ring. Arch Pediatr Adolesc Med 2010; 164:673.
- Rawal S, Modi N, Lacey S, Keane M. Escherichia coli septicaemia arising as a result of an infected caput succedaneum. Eur J Pediatr 2006; 165:66.
- Chung HY, Chung JY, Lee DG, et al. Surgical treatment of ossified cephalhematoma. J Craniofac Surg 2004; 15:774.
- Wong CH, Foo CL, Seow WT. Calcified cephalohematoma: classification, indications for surgery and techniques. J Craniofac Surg 2006; 17:970.
- Chen MH, Yang JC, Huang JS, Chen MH. MRI features of an infected cephalhaematoma in a neonate. J Clin Neurosci 2006; 13:849.
- Chan MS, Wong YC, Lau SP, et al. MRI and CT findings of infected cephalhaematoma complicated by skull vault osteomyelitis, transverse venous sinus thrombosis and cerebellar haemorrhage. Pediatr Radiol 2002; 32:376.
- Plauché WC. Subgaleal hematoma. A complication of instrumental delivery. JAMA 1980; 244:1597.
- Uchil D, Arulkumaran S. Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction. Obstet Gynecol Surv 2003; 58:687.
- Gebremariam A. Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors. Ann Trop Paediatr 1999; 19:45.
- Kilani RA, Wetmore J. Neonatal subgaleal hematoma: presentation and outcome--radiological findings and factors associated with mortality. Am J Perinatol 2006; 23:41.
- Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ 2001; 164:1452.
- Amar AP, Aryan HE, Meltzer HS, Levy ML. Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature. Neurosurgery 2003; 52:1470.
- Podoshin L, Gertner R, Fradis M, Berger A. Incidence and treatment of deviation of nasal septum in newborns. Ear Nose Throat J 1991; 70:485.
- Sooknundun M, Kacker SK, Bhatia R, Deka RC. Nasal septal deviation: effective intervention and long term follow-up. Int J Pediatr Otorhinolaryngol 1986; 12:65.
- Holden R, Morsman DG, Davidek GM, et al. External ocular trauma in instrumental and normal deliveries. Br J Obstet Gynaecol 1992; 99:132.
- Looney CB, Smith JK, Merck LH, et al. Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology 2007; 242:535.
- Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 1999; 341:1709.
- Pollina J, Dias MS, Li V, et al. Cranial birth injuries in term newborn infants. Pediatr Neurosurg 2001; 35:113.
- Whitby EH, Griffiths PD, Rutter S, et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 2004; 363:846.
- Chamnanvanakij S, Rollins N, Perlman JM. Subdural hematoma in term infants. Pediatr Neurol 2002; 26:301.
- Huang AH, Robertson RL. Spontaneous superficial parenchymal and leptomeningeal hemorrhage in term neonates. AJNR Am J Neuroradiol 2004; 25:469.
- Heyman R, Heckly A, Magagi J, et al. Intracranial epidural hematoma in newborn infants: clinical study of 15 cases. Neurosurgery 2005; 57:924.
- Park SH, Hwang SK. Surgical treatment of subacute epidural hematoma caused by a vacuum extraction with skull fracture and cephalohematoma in a neonate. Pediatr Neurosurg 2006; 42:270.
- Negishi H, Lee Y, Itoh K, et al. Nonsurgical management of epidural hematoma in neonates. Pediatr Neurol 1989; 5:253.
- Hayden CK Jr, Shattuck KE, Richardson CJ, et al. Subependymal germinal matrix hemorrhage in full-term neonates. Pediatrics 1985; 75:714.
- Beall MH, Ross MG. Clavicle fracture in labor: risk factors and associated morbidities. J Perinatol 2001; 21:513.
- Hsu TY, Hung FC, Lu YJ, et al. Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome. Am J Perinatol 2002; 19:17.
- Lam MH, Wong GY, Lao TT. Reappraisal of neonatal clavicular fracture: relationship between infant size and neonatal morbidity. Obstet Gynecol 2002; 100:115.
- Oppenheim WL, Davis A, Growdon WA, et al. Clavicle fractures in the newborn. Clin Orthop Relat Res 1990; :176.
- Bhat BV, Kumar A, Oumachigui A. Bone injuries during delivery. Indian J Pediatr 1994; 61:401.
- Caviglia H, Garrido CP, Palazzi FF, Meana NV. Pediatric fractures of the humerus. Clin Orthop Relat Res 2005; :49.
- Nadas S, Gudinchet F, Capasso P, Reinberg O. Predisposing factors in obstetrical fractures. Skeletal Radiol 1993; 22:195.
- Thompson KA, Satin AJ, Gherman RB. Spiral fracture of the radius: an unusual case of shoulder dystocia-associated morbidity. Obstet Gynecol 2003; 102:36.
- Sawant MR, Narayanan S, O'Neill K, Hudson I. Distal humeral epiphysis fracture separation in neonates -- diagnosis using MRI scan. Injury 2002; 33:179.
- Jones GP, Seguin J, Shiels WE 2nd. Salter-Harris II fracture of the proximal humerus in a preterm infant. Am J Perinatol 2003; 20:249.
- Dunkow P, Willett MJ, Bayam L. Fracture of the humeral diaphysis in the neonate. J Obstet Gynaecol 2005; 25:510.
- Morris S, Cassidy N, Stephens M, et al. Birth-associated femoral fractures: incidence and outcome. J Pediatr Orthop 2002; 22:27.
- Anglen JO, Choi L. Treatment options in pediatric femoral shaft fractures. J Orthop Trauma 2005; 19:724.
- Dupuis O, Silveira R, Dupont C, et al. Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates. Am J Obstet Gynecol 2005; 192:165.
- Wei C, Stevens J, Harrison S, et al. Fractures in a tertiary Neonatal Intensive Care Unit in Wales. Acta Paediatr 2012; 101:587.
- Broker FH, Burbach T. Ultrasonic diagnosis of separation of the proximal humeral epiphysis in the newborn. J Bone Joint Surg Am 1990; 72:187.
- Paige ML, Port RB. Separation of the distal humeral epiphysis in the neonate. A combined clinical and roentgenographic diagnosis. Am J Dis Child 1985; 139:1203.
- Menticoglou SM, Perlman M, Manning FA. High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86:589.
- Uhing MR. Management of birth injuries. Pediatr Clin North Am 2004; 51:1169.
- RISK FACTORS
- SOFT TISSUE INJURIES
- Bruising and petechiae
- Subcutaneous fat necrosis
- EXTRACRANIAL INJURIES
- Caput succedaneum
- Subgaleal hemorrhage
- Facial injuries
- - Nasal septal dislocation
- - Ocular injuries
- INTRACRANIAL HEMORRHAGE
- Subdural hemorrhage
- Subarachnoid hemorrhage
- Epidural hemorrhage
- Intraventricular hemorrhage
- Premature infants
- NEUROLOGIC INJURIES
- ABDOMINAL INJURIES
- SUMMARY AND RECOMMENDATIONS