DR ELEJE-BIRTH INJURIES MAY 2022 AND RESCUSCITATION OF NEWBORN.pptx

DR ELEJE'S LECTURE BIRTH INJURIES AND RESUSCITATION OF NEWBORN BY DR G.U. ELEJE [MBBS, FMCOG, FWACS, FICS] 02/06/2024 [email protected]; [email protected] Learning Objectives To understand different types of Birth injuries and their management protocol. To understand the rationale and importa...

DR ELEJE'S LECTURE BIRTH INJURIES AND RESUSCITATION OF NEWBORN BY DR G.U. ELEJE [MBBS, FMCOG, FWACS, FICS] 02/06/2024 [email protected]; [email protected] Learning Objectives To understand different types of Birth injuries and their management protocol. To understand the rationale and importance of neonatal Resuscitation in Nigeria Summarize the current evidence for DR ELEJE'S LECTURE 02/06/2024 Resuscitation of newborn in Nigeria DEFINITION AND EPIDEMIOLOGY Birth injuries is an impairment of the infant’s body function or structure due to adverse influences that occurred at birth  Injuries to the infant that result from mechanical forces (i.e., compression, traction)and anoxic forces during the birth process (labour & delivery) are categorized as birth trauma/ injury.  Even though most women give birth in modern hospitals surrounded by medical professionals, seven of every 1,000 births result in birth injuries  Birth injuries account for fewer than 2% of neonatal deaths.  Some injuries may be latent initially but later result in severe illness  DR ELEJE'S LECTURE 02/06/2024 PREDISPOSING FACTORS TO BIRTH INJURIES Prolonged or Obstructed Labour Rapid delivery (Precipitate Labour-ie labour lasting within 3 hours)  Cephalopelvic disproportion, Small maternal stature [Height less than 1.52m] Maternal pelvic anomalies  Deep transverse arrest of presenting part of the fetus  Shoulder Distocia Oligohydramnios Abnormal presentation (breech) Use of midcavity forceps or vacuum extraction Very low birth weight infant or extreme prematurity Fetal macrosomia – birth weight greater than 4.2kg Fetal anomalies   DR ELEJE'S LECTURE 02/06/2024 Classification of birth injuries: Soft tissue (most common) - Abrasions - Erythema petechia - Ecchymosis - Lacerations - Subcutaneous fat necrosis  Skull - Caput succedaneum Cephalhaematom a - Subgaleal haemorrhage - Linear fractures - Intracranial DR ELEJE'S LECTURE 02/06/2024   Cranial nerve and Face spinal cord - Subconjunctival haemorrhage injuries - Retinal - Facial palsy haemorrhage  Musculoskeletal  Peripheral nerve injuries - Brachial plexus Clavicular palsy fractures - Unilateral vocal - Fractures of long cord paralysis bones - Radial nerve - Sternocleidopalsy mastoid injury - Lumbosacral DR ELEJE'S LECTURE 02/06/2024 plexus injury   - Intra-abdominal injuries Liver haematoma Splenic haaematoma Adrenal hemorrhage Renal haemorrhage DR ELEJE'S LECTURE 02/06/2024 Abrasions and lacerations:     Sometimes may occur as scalpel cuts during Caesarean delivery or during instrumental delivery (i.e, vacuum, forceps) Infection remains a risk, but most uneventfully heal. Management consists of careful cleaning, application of antibiotic ointment, and observation Lacerations occasionally require suturing. DR ELEJE'S LECTURE 02/06/2024 Subcutaneous fat necrosis.    Irregular, hard, nonpitting, subcutaneous induration with overlying dusky red-purple discoloration on the extremities, face, trunk, or buttocks may be caused by pressure during delivery No treatment is necessary Subcutaneous fat necrosis sometimes calcifies. DR ELEJE'S LECTURE 02/06/2024  Caput succedaneum Is oedema of the presenting part caused by pressure during a vaginal delivery. This is a serosanguineous, subcutaneous, extraperiosteal fluid collection 02/06/2024 DR ELEJE'S LECTURE with poorly  Cephalhaematoma  Is a subperiosteal collection of blood between the skull and the periosteum. It may be unilateral or bilateral, and appears within hours (12-24 hours)of delivery (never present at birth)as a soft, fluctuant swelling on the side of the head. A cephalhaematoma never extends beyond the edges of the bone 02/06/2024 DR ELEJE'S LECTURE DR ELEJE'S LECTURE 02/06/2024 Cranial X-ray of the girl with cephalohematoma DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 Subgaleal haematoma Is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis. (і) Shock and pallor: tachycardia, a low blood pressure, within 30 minutes of the haemorrhage the haemoglobin and packed cell volume start to fall rapidly. (ii) Diffuse swelling of the head. Sutures usually are not palpable. The amount of blood under the scalp is far more than is estimated. Within 48 hours the blood tracks between the fibres of the occipital and frontal muscles causing bruising behind the ears, along the posterior hair line and around the eyes.  DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 Intracranial haemorrhages.   Extradural (epidural): Usually associated with fracture skull bone Subdural (i) Shock and/or anaemia due to blood loss. (ii) Neurological signs due to brain compression, e.g. convulsions, apnoea, a dilated pupil or a depressed level of consciousness. (iii) A full fontanelle and splayed sutures due to raised intracranial pressure. DR ELEJE'S LECTURE 02/06/2024 Subarachnoid haemorrhages (SAH) (i) Attacks of secondary asphyxia and apnoe, irregular breathing, bradycardia. (ii) Hyperestesia, tremor, seizures, bulging of fontanelle. (iii) Changes of spinal fluid in lumbar puncture: it becomes xanthochromic or/and contains blood Intraventricular (IVH) haemorrhages This is one of the most feared complications of prematurity Severe IVH is a major risk for adverse longterm neurodevelopmental outcome Most IVH occurs during the first postnatal day, few cases occur after 5 days of life DR ELEJE'S LECTURE 02/06/2024 Subconjunctival haemorrhage  Is the breakage of small blood vessels in the eyes of a baby  One or both of the eyes may have a bright red band around the iris.  This is very common and does not cause damage to the eyes.  The redness is usually absorbed in 7 to 10 days. DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 Brachial plexus injury    Erb palsy (C5-C6) is most common and is associated with lack of shoulder motion. The involved extremity lies adducted, prone, and internally rotated. Moro, biceps, and radial reflexes are absent on the affected side. Grasp reflex is usually present. Klumpke paralysis (C 7-8, T1) is rare and results in weakness of the intrinsic muscles of the hand; grasp reflex is absent.There is paralysis of the muscles of the fore arm. The arm is flexed at the elbow, the wrist is extended If cervical sympathetic fibers of the Th 1 are involved, Horner syndrome (ipsilateral ptosis and miosis [small pupil]) is present. DR ELEJE'S LECTURE 02/06/2024    This baby presents with an asymmetric posture of the arms. The left arm is not flexed and hangs limply. The arm lies on the side with extension of the elbow, pronation of the forearm and flexion of the wrist (Waiter’s tip) The baby demonstrates the findings of a left-sided ERB PARALYSIS. 02/06/2024 DR ELEJE'S LECTURE  The total plexus palsy (Kerer’s paralyses) is the most disturbing of all. Its clinical features are:  adynamy  muscle hypotony  positive “scarf” symptom Kofferate syndrome (C 3-4) is the diaphragm paralysis. Because of irregular breathing, cyanosis pneumonia can be suggested DR ELEJE'S LECTURE 02/06/2024 mistakenly.       Facial paralysis: Can be caused by pressure on the facial nerves during birth or by the use of forceps during birth This because, the facial nerve remains unprotected after its exit through the stylomastoid foramen The affected side of the face droops and the infant is unable to close the eye tightly on that side. When crying the mouth is pulled across to the normal side. No nasolabial fold is present. Sucking remains unaffected Treatment aims at protecting the eye, which remains open even during sleep with synthetic tears (1% methyl cellulose drops) The condition usually disappears within weeks unless complicated by intracranial damage DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 Spinal cord injury Is incurred during delivery results from excessive traction or rotation.  failure to establish adequate respiratory function,  the baby usually is posing as frog,  “oscillation” symptom is positive (if to prick leg of the newborn with needle leg will flex and extend in all joints several times).  DR ELEJE'S LECTURE 02/06/2024 The clavicle fracture is the most frequently bone injure in the neonate during birth and most often is an unpredictable unavoidable complication of normal birth. The infant may present with pseudoparalysis. Examination may reveal crepitus, palpable bony irregularity, and sternocleidomastoid muscle spasm. Desault's bandage should be used DR ELEJE'S LECTURE 02/06/2024 for 7-10 days. FRACTURES OF THE LONG BONES (Humerus and Femur)           These normally occur in breech delivery Fractures are usually greenstick in type but may be complete Rapid union occurs with callus formation Deformity is a rarity even where the bone ends are not in good alignment Treatment: Fracture femur and humerus are treated by immobilization Xray studies are done Closed reduction and casting are needed when bones are displaced Limb motion is restricted Healing with callus formation occurs over 2 to 4 weeks. Usually, there is complete recovery DR ELEJE'S LECTURE 02/06/2024 DR ELEJE'S LECTURE 02/06/2024 NEONATAL RESUSCITATION NEONATAL RESUSCITATION  DR ELEJE'S LECTURE 02/06/2024 OUTLINE OF PRESENTATION         Introduction Perinatal physiology Causes of Perinatal Asphyxia (PA) APGAR Scores Goals of Resuscitation Preparation for resuscitation Resuscitation procedure Conclusion DR ELEJE'S LECTURE 02/06/2024 Introduction Perinatal Asphyxia (PA) is clinically defined as the inability of the newborn to initiate and sustain normal respiration at birth.  Also known as hypoxia-ischaemia  Asphyxia is incapacity of newborn to begin or to support of spontaneous respiration after delivery due to breaching of oxygenation during labor and delivery [WHO]  Characterized by    fetal/neonatal acidaemia (PH100/min DR ELEJE'S LECTURE 02/06/2024 APGAR score 0-2        Apnoic HR