Saturday, June 15, 2024

Birth Trauma

Overview

Injuries to the infant that result from mechanical forces (ie, compression, traction) during the birth process are categorized as birth trauma. Factors responsible for mechanical injury may coexist with hypoxic-ischemic insult; one may predispose the infant to the other. Lesions that are predominantly hypoxic in origin are not discussed in this article.

Significant birth injury accounts for fewer than 2% of neonatal deaths and stillbirths in the United States; it still occurs occasionally and unavoidably, with an average of 6-8 injuries per 1000 live births. In general, larger infants are more susceptible to birth trauma. Higher rates are reported for infants who weigh more than 4500g.

Most birth traumas are self-limiting and have a favorable outcome. Nearly one half are potentially avoidable with recognition and anticipation of obstetric risk factors. Infant outcome is the product of multiple factors. Separating the effects of a hypoxic-ischemic insult from those of traumatic birth injury is difficult.

Risk factors for birth trauma include the following
:

Large-for-date infants, especially infants who weigh more than 4500 g

Instrumental deliveries, especially forceps (midcavity) or vacuum

Vaginal breech delivery

Abnormal or excessive traction during delivery

Occasionally, injury may result from resuscitation. Recognition of trauma necessitates a careful physical and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated.

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