Newborn Health Problems

Newborn Health Problems

• Birth Injuries: Several types, including soft tissue injuries, head injuries, and nerve injuries. Other types also exist.
• Predisposing Factors: Maternal factors, fetal factors, and iatrogenic factors (unintentional medical errors). Some injuries are minor and self-limiting, others are life-threatening.

Soft Tissue Injury

• Cause: Disproportion between the presenting part of the baby and the mother's pelvis (cephalopelvic disproportion). Difficult deliveries (e.g., forceps, breech, brow deliveries) can cause discoloration or abrasions.
• Manifestations: Discoloration/abrasions on the face, matching the forceps shape
• Petechiae/ecchymoses (bruising) on presenting part, after difficult or rapid deliveries, this can also be generalized on the face and head.
• Petechiae/ecchymoses can also appear on infants with nuchal cords, which could lead to a cyanotic face appearance.
• A vacuum suction cup can cause petechiae/ecchymoses in the occipital region of the infant's head.
• Lacerations can occasionally occur during cesarean section.
• Treatment: Healing usually occurs spontaneously in a few days.

Head Injury

• Cephalhematoma: Collection of blood between the bone and its periosteum. Usually distinguishable, limited to the boundary of the bone, it is common in first-time mothers. This often appears between the first and second day.
• Caput Succedaneum: Swelling of the scalp associated with edema. Often larger than the bone’s boundaries and typically present at or shortly after birth. It normally resolves within a few days or 12 hours.
• Cause: Cephalhematoma is more commonly seen in first-time mothers and is linked to forceps deliveries and vacuum extraction.

Nerve Injuries

• Facial Paralysis: Pressure on the facial nerve (7th cranial nerve) during delivery can cause injury.
• Manifestations: Affected side movement loss (e.g., inability to close the eye, drooping mouth, flat forehead, nasolabial fold). More noticeable during crying. The eye on the affected side stays open.
• Treatment: Typically resolves spontaneously within a few days, possibly several months.
• Brachial Palsy: Injury to the brachial plexus, an intricate network of nerves in the shoulder.
• Causes: Can result from stretching or pulling away during a difficult delivery (e.g., shoulder dystocia). Risk factors include: larger babies, prior shoulder dystocia, specific deliveries (e.g., forceps, midpelvic).
• Types include Erb palsy, lower plexus palsy (Klumpke palsy) and total plexus injury.

Nursing Care Management

• General Care: Assessment, observation, and accurate documentation of injuries.
• Complications: Vigilance for potential complications like infection. Reassurance to parents, as most conditions resolve on their own.
• Specific Cases: Aiding feeding, correct positioning, passive range-of-motion exercises, Splinting to prevention of contractures, dressing/undressing protocols and positioning.