Neonatal Outcomes and Intraventricular Hemorrhage

Occurrence and Injuries

• Excessive abduction of the arm can cause injuries to the superior part of the plexus, which is less common than injuries to the inferior part.
• Roots involved in Klumpke's palsy are C8 and T1.
• Clinical appearance of Klumpke's palsy includes motor loss in the small muscles of the hand and sensory loss in the medial aspect of the upper limb.

Fractures

• Clavicle fractures require analgesia and limited movement to allow for callus formation.
• Humerus fractures require splinting for 2 weeks.
• Femoral fractures require traction, suspension, and spica cast analgesia, with immobilization for 14 days.

Cranial Nerve, Spinal Cord, and Peripheral Nerve Injury

• Cranial nerve injuries can occur to the facial and recurrent laryngeal nerves.
• Spinal cord injuries can include haematoma, vertebral injuries, transection, and occlusion.
• Phrenic nerve injuries can also occur.

Congenital Abnormalities

• Neural tube defects (NTDs) are caused by folic acid deficiency, maternal anticonvulsants, maternal diabetes, irradiation, maternal hyperthermia, and amniotic band syndrome.
• Primary NTDs include meningomyelocele, encephalococele, and anencephaly.
• Secondary NTDs include meningocoele, which involves the skin and dura but not neural elements.
• Prognosis of NTDs depends on the level of the lesion, and surgery does not reverse the insult.

Cleft Lip and Palate

• Cleft lip and palate are the commonest craniofacial anomaly, with cleft lip being twice as common on the left side as on the right side.
• Cleft lip is more common in males, while cleft palate is more common in females.
• Cleft lip and palate can be syndromic, maternal, phenytoin-induced, or familial.
• Treatment involves a multidisciplinary team, including a surgeon, speech therapist, psychologist, geneticist, and paediatrician.
• Surgery is performed according to the lesion, and assistance with feeding requires specialized teats.

Hydrocephalus

• Causes of hydrocephalus include congenital malformations (aqueduct stenosis, Chiari malformation, Dandy Walker malformation), post-haemorrhagic (IVH, SAB, trauma, Vit K deficiency), post-infective (neonatal meningitis, intrauterine viral infection), neoplastic lesions, vascular malformations, and choroid plexus papilloma.

Genetics

• Trisomy 21 is a genetic disorder characterized by epicanthic folds, upslanting palpebral fissures, Brushfield spots on the iris, flat nasal bridge, protruding tongue, brachycephaly, single palmer crease, hypotonia, and saddle gap.
• Trisomy 18 is a genetic disorder that occurs in 1/1,300 conceptions and 1/6,000 live births, with 95% non-dysjunction and 5% translocation or mosaics.
• Trisomy 13 is a genetic disorder that occurs in 1/9,500 live births, with a median survival of 7-10 days and 90% mortality within the first year of life.

Teratogens

• Teratogens include drugs (warfarin, anticonvulsants, alcohol, recreational drugs, antipsychotics), heavy metals (lead, mercury), radiation, maternal conditions (IDDM, SLE, Graves' disease), infections (CMV, herpes simplex, rubella, varicella), and other exposures (gasoline fumes, heat, hypoxia, maternal smoking).

Feeding Problems

• Feeding problems can occur in cleft lip and palate, micrognathia, TOF, premature babies, asphyxiated babies, and other congenital abnormalities.
• Post-surgery feeding problems can also occur.

Visual Impairment

• Visual impairment can occur due to ROP (dental enamel hypoplasia) and bilirubin-induced cell toxicity.
• Kernicterus is a rare condition that can occur due to bilirubin-induced cell toxicity, with a high mortality rate and severe neurological signs.

IVH and PVL

• IVH (intraventricular haemorrhage) is a condition that occurs in grades 1-4, with grade 1 being germinal matrix bleeding and grade 4 being grade 3 with parenchymal haemorrhage.
• PVL (periventricular leukomalacia) is a condition that occurs in two forms: "classic" focal PVL and diffuse PVL.
• PVL is a risk factor for motor and cognitive impairment, as well as behavioral problems.

Long-term Outcomes

• Long-term outcomes of IVH and PVL include neurological impairment, cognitive and language impairments, sensory impairments, and increased rates of readmission.

Osteopenia of Prematurity

• Osteopenia of prematurity is a condition that occurs due to nutritional needs not being met, accelerated growth, and drug use (diuretics, steroids, TPN).
• Management involves high-dose vitamin D and passive limb therapy.

Meconium Aspiration Syndrome

• Meconium aspiration syndrome is a condition that occurs due to meconium aspiration, with a risk of airleak syndrome, requiring gentle physiotherapy.

Neonatal Encephalopathy/Asphyxia

• Neonatal encephalopathy/asphyxia is a condition that occurs due to impairment of maternal oxygenation, decreased blood flow from mother to placenta, decreased blood flow from placenta to foetus, impaired gaseous exchange from placenta to foetus, and increased foetal oxygen requirements.
• Clinical examination includes low apgars, decreased tone, lethargy, seizures, apneoa, and absent primitive reflexes.

Complications

• Complications of neonatal encephalopathy/asphyxia include seizures, feeding difficulties, aspiration pneumonia, contractures, sensory impairment, and motor impairment (spastic CP).

Birth Trauma

• Birth trauma is an impairment of the infant's body function or structure due to adverse influences that occurred at birth.
• Risk factors include primiparity, small maternal stature, maternal pelvic anomalies, prolonged or precipitous labour, oligohydramnios, malpresentation, instrumental deliveries, and fetal anomalies.

Head Injuries

• Head injuries can occur, including cephalohaematoma.

Brachial Plexus Injuries

• Erb's palsy is a brachial plexus injury that occurs due to injury to the superior part of the plexus, with a characteristic "waiter's tip" position.
• Clinical appearance of Erb's palsy includes motor loss in the adducted shoulder, medially rotated arm, and extended elbow, with sensory loss in the lateral aspect of the upper limb (uncommon).