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Sign and symptom of birth injury

Caput succedaneum
• Present at birth
• Oedema deformity known as chignon(the large artificially created
caput succedaneum associated with vacuum delivery)
• Can pit on pressure
• Can cross suture line
• Oedema may move to dependant area of scalp
• The baby will experience discomfort
Management
1. Assesment
-skin colour:pink
Identified injury:
-oedema
-pit on pressure
-cross suture line
-oedema may move to dependant area of scalp
-the baby will experience discomfort
vital sign:spo2,weight,length,head circumference
2. Support of the affected part
3. Transfusion and phototherapy maybe necessary if blood accumulation
is significant
Soft tissue injury
Sign and symptom
• Skin:abrasions/bruising/fat necrosis,laceration

Management:
1. Assesment
-skin colour:pink
-identified injury:scar,scalp abrasions,lesions
-behavior:crying
- v/sign:spo2,weight,length,head circumference
2.dressing:aseptic,clean and dry
3.Inform doctor if deeper laceration
Health education
• Emotional support
• Kept wound clean and dry
• Educate parents to bring the baby for medical consultation if there are
sign of infection(redness,warm and fever)
• Antibiotic may be required
Fractures
Midclavicular fracture
• baby irritable
• May not move the arm
• Involved side either spontaneously or when the Moro reflex is elicited
• The affected shoulder may appear slightly lower than uninjured
shoulder.
Danger/complication
-inability to move the arm due to an injury to the brachial plexus or
collection of nerves of the arm
Management
• Clavicular fractures heal rapidly and uneventfully
• Occurs in 7-10 days
• Immobilizing the arm for 14 days by pinning the shirt sleeve of the
involved side to the opposite side of the infant’s shirt
Humerus and femur fracture
• Crepitus
• Pain-crying
• Reluctant to move-affected area
Management
• Immobilization of fracture side
• Placing pad and splint with bandage
• Carefull handling,cleansing and dressing
• Mild anagesic:paracetamol
• Positioning
• Occur in 2-3 weeks
Torticollis
• Aterocollis:the head is tipped toward the shoulder
• Rotational torticollis:the head rotates along the longitudinal axis
• Anterocollis:forward flexion of the head and neck
• Rectrocollis:hyperextension of head and neck backward
Intracranial injuries
• Lethargy
• Neonatal seizures
• Apnea
• Feeding difficulties
• Irritability
• Bulging fontanelle/soft spot
• Shallow or strained breathing
• Abnormal tone
• Altered level of consciousness
Management
• Radiographs:cranial USG,CT scan,Skull
• Subdural tapping
• Observation:
-hourly vital sign(detect bleeding)
-skin:cyanosis
-activities:motor reflex,active or not
-crying:good,high piched or shrill crying
• Avoid intracranial pressure increase
-minimal handling
-treat baby in incubator
-treatment planning to limit infection potential
Cerebospinal fluid
• Drowsiness
• Separated sutures on the skull
• Bulging of the soft spot on top of the head(bulging fontanelle)
• Vomitting

Management
• Breathing support
• Draining of cerebrospinal fluid to lower pressure in the brain
• Medicines to decrease swelling
Causes of birth injuries
• Brain injuries:
-anoxia:oxygen deprivation to the baby’s brain may cause brain injury
and just a few minutes without oxygen may be enough to have lifelong
impact.
-hypoxia:decreased flow of oxygen to the brain.
-physical trauma to head:physical damage to the baby’s neck or
head(improper use of instruments such as forceps )
-infections and health problem:if a mother suffers a health problem
before or during pregnancy
• Shoulder dystocia
-the baby’s head is born but one shoulder becomes stuck behind the
mother’s pubic bone
• Brachial plexus
-occurs when the nerves in the baby’s neck are damaged during
delivery(can cause loss of movement and sensation in the arm)
• Fractures
-excessive twisting or pulling of the baby during delivery
-improper use of instruments,such as forceps
-shoulder dystocia