Health Problems of the Newborn PDF

Health Problems of the Newborn BIRTH INJURIES:- 1. Soft tissue injuries 2. Head injuries 3. Nerve injuries 4. Others..eg ##  introduction many factors predispose to birth injuries: 1. Maternal factors 2. Fe...

Health Problems of the Newborn BIRTH INJURIES:- 1. Soft tissue injuries 2. Head injuries 3. Nerve injuries 4. Others..eg ##  introduction many factors predispose to birth injuries: 1. Maternal factors 2. Fetal factors 3. Iatrogenic :- induced unintentionally by a physician or surgeon or by medical treatment or diagnostic procedures.  Some injuries are minor & self limiting others are life-threatening  SOFT TISSUE INJURY Cause: Soft tissue injury usually occurs when there is some degree of disproportion between the presenting part and the maternal pelvis (cephalopelvic disproportion). 1. The use of forceps to facilitate a difficult vertex delivery may produce discoloration or abrasions with the same configuration as the forceps on the sides of the neonate’s face. 2. Petechiae or ecchymoses may be observed on the presenting part after a breech or brow delivery. 3. After a difficult or precipitous delivery ‫والدة سريعة‬, the sudden release of pressure on the head can produce scleral hemorrhages or generalized petechiae over the face and head. 4. Petechiae and ecchymoses may also appear on the head, neck, and face of an infant born with a nuchal cord, giving the infant’s face a cyanotic appearance. 5. A well-defined circle of petechiae and ecchymoses may also appear on the occipital region of the newborn’s head when a vacuum suction cup is applied during delivery. 6. Rarely, lacerations occur during cesarean section. treatment: These traumatic lesions generally fade spontaneously and without treatment within a few days. HEAD INJURY Cephalhematoma Caput succedaneum  Caput succedaneum Is a vaguely ‫ بغموض‬outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery. The swelling consists of serum and/or blood that has accumulated in the tissues above the bone. Typically the swelling extends beyond the bone margins (or sutures) and may be associated with overlying petechiae or ecchymosis. It is present at or shortly after birth. Treatment:-  No specific treatment is necessary  the swelling subsides within a few days.  Cephalhematoma It forms when blood vessels rupture during labor or delivery and produce bleeding into the area between the bone and its periosteum.  Cause:- The injury occurs most often with primiparous‫ بدائي‬women and is often associated with forceps delivery and vacuum extraction.  Manifestations:- the boundaries of the cephalhematoma are distinguishable do not extend beyond the limits of the bone. They may involve one or both parietal bones but rarely affects the occipital and frontal bones. The swelling is usually minimal or absent at birth and increases in size on the second or third day. Blood loss is usually not significant.  ………….. Cephal……..2  TREATMENT: No treatment is indicated for uncomplicated cephalhematoma. Most lesions are absorbed within 2 weeks to 3 months.  COMPLICATIONS:- 1. Lesions that result in severe blood loss to the area 2. May involve an underlying fracture require further evaluation. 3. Hyperbilirubinemia may result during resolution of the hematoma. 4. A local infection can develop and is suspected when swelling suddenly increases  Nursing Care Management Nursing care is directed toward assessment, observation, and accurate documentation of the common scalp injuries. Vigilance in observing for possible associated complications, such as infection Because caput succedaneum and cephalhematoma usually resolve spontaneously, parents need reassurance of their usually benign nature  NERVE INJURIES 1. Facial Paralysis 2. Brachial Paralysis  Facial paralysis Facial Paralysis Pressure on the facial nerve (7th cranial nerve) during delivery may result in injury to the nerve.  Manifestations:- The primary clinical manifestations are loss of movement on the affected side, such as an inability to completely close the eye, drooping of the corner of the mouth, and absence of wrinkling of the forehead and nasolabial fold. The paralysis is most noticeable when the infant cries. The mouth is drawn to the unaffected side, the wrinkles are deeper on the normal side, and the eye on the involved side remains open.  Treatment: No medical intervention is necessary. The paralysis usually disappears spontaneously in a few days but may take as long as several months.  Brachial Palsy Brachial plexus injury results from forces that alter the normal position and relationship of the arm, shoulder, and neck. Causes: 1. Erb palsy (Erb-Duchenne paralysis) is caused by damage to the upper plexus and usually results from stretching or pulling away of the shoulder from the head, as might occur with shoulder dystocia or with a difficult vertex or breech delivery. 2. Other identified clinical situations that are considered to place the baby at risk for brachial palsy include :  a significantly larger than normal baby with a fetal weight exceeding 5000 g in women without diabetes or 4500 g in women with diabetes,  prior recognized shoulder dystocia,  or a midpelvic operative vaginal delivery with a fetal birth weight in excess of 4000 g.  Types& Manifestations A) Erb palsy (Erb-Duchenne paralysis) : The clinical manifestations are related to the paralysis of the affected upper extremity and muscles. The arm hangs limp alongside the body. The shoulder and arm are adducted and internally rotated. The elbow is extended and the forearm is pronated, with the wrist and fingers flexed; a grasp reflex may be present because finger and wrist movement remain normal B) lower plexus palsy(Klumpke palsy) : results from severe stretching of the upper extremity while the trunk is relatively less mobile. In lower plexus palsy the muscles of the hand are paralyzed, with consequent wrist drop and relaxed fingers. C) total plexus injury: the more severe form of brachial palsy – the entire arm and hand are paralyzed and hang limp and motionless at the side. The Moro reflex is absent on the affected side for all forms of brachial palsy  Treatment…… Treatment of the affected arm is aimed at: 1. preventing contractures of the paralyzed muscles and 2. maintaining correct placement of the humeral head within the glenoid fossa of the scapula. Complete recovery from stretched nerves usually takes 3 to 6 months. but there are specific peripartum and neonatal factors associated with persistent neonatal brachial plexus palsy at 1 year :-  Cephalic presentation, induction of labor, birth weight greater than 9 pounds, and the presence of Horner syndome significantly increase the odds of persistence of brachial palsy.  Cesarean delivery and Narakas grade I to II injury (Narakas grading defines the severity of nerve damage) significantly reduced the chance of brachial palsy continuing after 1 year. For those injuries that do not improve spontaneously by 3 months, surgical intervention may be needed to relieve pressure on the nerves or to repair the nerves with grafting In some cases injection of botulinum toxin A into the pectoralis major muscle may be effective in reducing muscle contractures after birth-related brachial plexus injuries  COMPLICATIONS Torticollis: is observed as a tilting of the head to one side in combination with rotation of the head to the opposite side due to the unilateral contracture of the sternocleidomastoid muscle. it has been reported to occur in as many as 43% of infants with brachial plexus injury. Torticollis may also occur in older infants with positional plagiocephaly and in association with other conditions such as spinal cord tumors, clavicle fracture, congenital scoliosis, Klippel-Feil anomalies, and cervical spine subluxation. The treatment of torticollis involves massage, stimulation, and stretching programs under the supervision of a physical therapist  Nursing Care Management Facial nerve paralysis involves: 1. aiding the infant in suckling and helping the mother with feeding techniques. 2. The infant may require partial gavage feeding and supplemental oral stimulation with a minimum amount of expressed breast milk to prevent aspiration. 3. Breastfeeding is recommended and the mother will need assistance in helping the infant grasp and compress the areolar area to ensure effective milk transfer from the mother to the infant. 4. If the lid of the eye on the affected side does not close completely, instill artificial tears as needed to prevent drying of the conjunctiva, sclera, and cornea. 5. The lid is often taped shut to prevent injury.  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*  Brachial Palsy ……….NSG Nursing care for NB with brachial palsy is concerned primarily with proper positioning of the affected arm. The affected arm should be gently immobilized on the upper abdomen; passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated at 7 to 10 days of age Wrist flexion contractures may be prevented with the use of supportive splints or braces. In dressing the infant, give preference to the affected arm. Undressing begins with the unaffected arm, and redressing begins with the affected arm to prevent unnecessary manipulation and stress on the paralyzed muscles. Teach parents to use the “football” position when holding the infant and to avoid picking the child up from under the axillae or by pulling on the arms.*