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Background: Birth injury is defined as structural damage of a newborn secondary to mechanical forces that occur during labor and/or delivery. This study determined the incidence, risk factors and outcome of birth injury. Methodology: This was an observational study of birth injuries in neonates, over a period of one year, carried out at a tertiary hospital in Enugu, south east, Nigeria. Results: Out of the 1,735 births recorded during the period of the study, there were 19 cases of birth injuries. This gave an incidence of 11 per 1000 live births. No neonate had more than one injury. They were thirteen males and six females that sustained birth injury. Cephalohematoma was the most common birth injury. Others are caput succedaneum, clavicular fracture, Erb’s palsy, femoral fracture, humeral fracture, shoulder dislocation and facial laceration. Mode of delivery, neonatal birth weight, gestational age and maternal parity were significant predictive risk factors for birth injury. Conclusion: In the current study, cephalohematoma was the most common birth injury, followed by caput succedaneum. There is need to reduce the morbidity and mortality associated with birth injuries.

Newborn jaundice is an apparent yellowing of the sclera or yellowish skin in newborn infants. This symptom is caused by a yellow pigment known as bilirubin. A high level of bilirubin in the infant is referred to as hyperbilirubinemia. Significant complications can occur if significantly increased bilirubin levels are not treated promptly. Severe hyperbilirubinemia can be caused by dehydration, lack of adequate nutritional intake, extravasation of blood, cephalohematoma, contusions and asphyxia, and may potentially cause kernicterus. Because many of these problems affect newborns, they may require critical care from specialty medical disciplines. Thus, in this paper we proudly proposed a Combination of pre-processing and the skin color detection method to detect jaundiced infants. Few statistical features are derived from the texture images and used as features to quantify infant image textures. Finally, a k-NN is employed as classifier for discriminating infant image textures. The experimental results reveal that the proposed method can act as a supplement to support earlier detection and more effective treatment due to improved jaundice recognition.

SUMMARY: Fluid-fluid levels can occur whenever different fluid densities are contained within a cystic or compartmentalized lesion, usually related to the evolution of hematoma or necrosis. Review of the literature demonstrated that throughout the skeletal system, the most common etiology for fluid-fluid levels is aneurysmal bone cyst, but there are no dedicated studies of the pediatric calvaria, to our knowledge. In this report, we present clinicopathologic characteristics and CT and MR imaging of 11 patients with pediatric skull mass lesions demonstrating fluid-fluid levels. MR imaging demonstrated more fluid-fluid levels compared with CT in all cases. The etiologies of skull lesions with fluid-fluid levels were Langerhans cell histiocytosis in 4 (36.6%), aneurysmal bone cysts in 3 (27.2%), cephalohematoma in 3 (27.2%), and metastatic neuroblastoma in 1 (9%). Radiologists should be aware of the other etiologies of calvarial lesions with fluid-fluid levels in the pediatric skull. ABC : aneurysmal bone cyst FFL : fluid-fluid level LCH : Langerhans cell histiocytosis

Neonatal subgaleal hematomas (SGHs) are rare but potentially life-threatening complications of vacuum extraction deliveries. We report a rare case of four enlarging SGHs in an 11-day-old boy born without use of instruments during delivery. It is likely that trauma from the provider's fingers caused these SGHs during a normal vaginal delivery. Ultrasound findings confirmed the diagnosis of SGH, distinct from other birth trauma such as cephalohematoma or caput succedaneum.

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery. Methods: A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed. Results: One hundred and four (2.9%) successful vacuum deliveries were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. Among the maternal morbidities, 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome. Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team. J. Lumbini. Med. Coll . Vol 4, No 2, July-Dec 2016, Page: 104-107 DOI: https://doi.org/10.22502/jlmc.v4i2.101

Cephalohematomas are relatively common sub-periosteal collections of blood that tend to resolve spontaneously without treatment. Rarely, they become infected and can be associated with underlying osteomyelitis, meningitis, or sepsis. Common pathogens include Escherichia coli and Staphylococcus species. This report describes the first case of a neonate developing an infected right parietal cephalohematoma and underlying osteomyelitis caused by Morganella morganii, which was cultured in blood and cephalohematoma aspirate. This infant male, whose risk factors included vacuum extraction during delivery and suspected post-natal pneumonia, responded well to a 6-week course of intravenous meropenem with complete resolution of both lesions. When an infected cephalohematoma is suspected, aspiration of hematoma fluid should be performed for both diagnostic and therapeutic purposes. Infectious symptoms should warrant prompt investigation and treatment, which may include drainage, debridement, and antibiotics. This report demonstrates that the combination of an infected cephalohematoma and underlying osteomyelitis might not be as uncommon as previously believed.

Aim: To compare the maternal and neonatal outcomes of symphysiotomy (SYM) and cesarean section (CS), when they were performed in women presenting with obstructed labor. Material and Methods: This was a prospective comparative cohort study. Symphysiotomy was performed in 25 women who presented with obstructed labor. The controls were 50 women on whom CS was performed due to obstructed labor. Maternal mortality and morbidity due to postpartum hemorrhage (PPH), sepsis, genitourinary trauma, pelvic pain and gait problems were analyzed and compared between cases and controls. Neonatal mortality and morbidity due to birth asphyxia, intracranial hemorrhage, cephalohematoma and hypoxic ischemic encephalopathy were also compared following the two procedures. Results: Maternal mortality was similar in both the cesarean section group (CSG) and symphysiotomy group (SG), but SYM has less morbidity than CS, and also preserves the uterus from scars. Transient pelvic pain was the most common maternal morbidity following SYM, whereas PPH and wound sepsis were the most common complications after CS. Neonatal mortality and morbidity were similar in both cases and controls. Lastly, SYM is a simple, low-cost and quicker procedure than CS. Conclusion: Symphysiotomy is an alternative management in women with obstructed labor. It has a role in low-resource settings, where CS is unaffordable, unavailable or unsafe. For the vast majority of the poor population, who may not have even have one proper meal a day, it can be of benefit to have a woman's pelvis made permanently adequate so that traditional birth attendants can conduct her subsequent labors.

Orbital wall infarctions resulting in orbital and epidural hematomas are rare manifestations of sickle cell disease (SCD). We report orbital compression syndrome associated with an epidural hematoma and wide cephalohematoma in a 15-year-old boy with SCD. An infarcted orbital bone was observed on magnetic resonance imaging and three-phase bone scintigraphy with Technetium-99m methylene diphosphonate. The patient recovered completely without surgical intervention at the end of the fourth week. Prompt diagnosis and proper management are critical for complete recovery.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder that occurs most commonly in the pediatric population as a result of pathological clonal proliferation of Langerhans cells with subsequent damage and destruction to surrounding tissue. Clinically, LCH presents in a variety of ways, which often results in prolonged time to diagnosis and subsequently poorer outcomes. In this case report, the authors describe an unusually early presentation of multisystem LCH in a patient at birth, which resulted in a 5-month delay to diagnosis and treatment. This patient presented both atypically young and with an uncommon initial manifestation of multisystem disease with multiple soft-tissue swellings rather than early skin involvement. Additionally, this patient had an unusual radiographic appearance with biparietal skull destruction on initial skull radiographs and biparietal soft-tissue lesions on CT resembling cephalohematoma at 3 months of age. The clinical and radiological evaluation, pathology, and treatment strategies are discussed, with particular attention paid to the importance of further workup of atypical nonresolving cephalohematomas to prevent disease progression and poorer outcomes.

Jaundice is a very well-known disease found worldwide. Jaundice comes from the French word “Jaune” - which means yellow. In medical term, jaundice is known as icterus which is a Greek word. This is a very common disease in the population, which causes the yellowish or greenish pigmentation in the skin and whiteness in the eyes. This is a condition of hyperbilirubinemia in which the amount of bilirubin increases in the blood. In this case, the high amount of bilirubin is found in blood, and the disruption of the movement of bilirubin into the liver and out of the body causes jaundice. Different symptoms seen in this case are yellow skin, yellow/white eyes, dark or reddish urine, loss of appetite, bitter taste of tongue, pale faces, nausea, itching in skin, anfd slow pulse rate. Jaundice may be mild to severe. Different types of jaundice are seen like normal jaundice in newborn, hepatic jaundice, and post-hepatic Jaundice.

Objective The objective of this study was to reinterpret the neurodevelopmental prognostic factors that are associated with birth head injury by performing a long-term follow-up. Methods Seventy-three neonates with head injuries were retrospectively analyzed after a duration of 10.0±7.3 years to determine the correlations between perinatal factors, including gender, head circumference, gestational age, body weight, and mode of delivery, and head injury factors from radiologic imaging with social, fine motor, language, and motor developmental quotients. Results There was a statistically significant difference between perinatal factors and head injury factors with respect to head circumference, body weight, gestational age, mode of delivery, Apgar scores at 1 min, cephalohematoma, subdural hemorrhage, subarachnoid hemorrhage, and hypoxic injury, but no direct correlation by regression analysis was observed between perinatal factors and developmental quotients. Of the head injury factors, falx hemorrhage showed a significant indirect relationship with the language and motor developmental quotients. Mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, epidural hemorrhage (EDH), tentorial hemorrhage, brain swelling, and hypoxic injury showed an indirect relationship with social development. Conclusion In terms of perinatal factors and head injury factors, mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, EDH, tentorial hemorrhage, falx hemorrhage, brain swelling, and hypoxic injury displayed an indirect relationship with long-term development, and therefore these factors require particular attention for perinatal care.

Epidural hematoma (EDH) is a rare complication of vacuum-assisted delivery in neonates. Although the standard treatment of EDH is surgical evacuation via craniotomy, it is an invasive procedure in neonates, and less invasive methods may be favored for hematoma evacuation. We report a case of 5-day-old infant with a massive EDH, cephalohematoma, and a depressed fracture, which were secondary to a vacuum-assisted delivery and cured by ultrasound-guided needle aspiration and drainage. Neonatal EDH may be different from adult counterpart in that the former is more liquefied and is amenable to needle aspiration than the latter. Although needle aspiration is a blind procedure, addition of transcranial ultrasound not only ensures safety by visualizing the tip of the needle but also makes real-time evaluation of the residual hematoma volume possible.

This report describes a 1-month-old female with bacteremia and meningitis complicated by an infected cephalohematoma that resulted from hematogenous seeding. This report serves as a reminder that, although occurring rarely, inflammation overlying a cephalohematoma in an infant with bacteremia can indicate focal infection that requires incision and drainage for resolution.

Craniosynostosis is the premature fusion of 1 or more of the cranial sutures, with sagittal synostosis being the most common nonsyndromic single suture synostosis. The pathogenesis of craniosynostosis has been extensively studied and is likely multi-factorial. A complex interaction between the dura and overlying suture via multiple growth factors seems to play the most important role. There have been 3 published studies with patients presenting with scaphocephaly and a cephalohematoma, which raises the question of how the 2 conditions may be related. Cephalohematomas can be seen after trauma and a number of other causative factors but usually resorb over time without sequela. In a small percentage of cases, the hematoma persists and calcifies, leading to significant asymmetry and deformity of the skull. Once it reaches this point, surgical intervention may be required to correct the resulting skull deformity. We present a child with scaphocephaly and a cephalohematoma who underwent surgical correction with resection of the cephalohematoma and sagittal suturectomy with spring-assisted surgery.

To compare maternal and neonatal outcomes of forceps delivery or cesarean section (CS) following failed vacuum extraction. A retrospective cohort study of all women who underwent forceps delivery and/or CS after failed vacuum extraction in 1993–2006 was conducted. Cases were identified by searching the computerized delivery discharge database. All files were reviewed and those who underwent CS were compared to those who underwent forceps delivery. Compared to CS (n = 112), forceps delivery (n = 328) was associated with a significantly higher risk of adverse composite maternal outcome (P = 0.001), third/fourth-degree perineal tears (P = 0.005), prolonged hospitalization (P = 0.03), and cephalohematoma (P = 0.04). In the forceps group, the risk was increased by nulliparity, occipito-posterior position, S + 1 station, and pre-pregnancy maternal obesity; in the cesarean group, higher maternal risk was associated with delivery in the evening/night and S + 2 or lower. In cases of nonreassuring fetal heart rate, composite neonatal outcome was worse after CS. Forceps delivery after failed vacuum extraction may be associated with greater short-term maternal morbidity than CS, although it might be associated with better perinatal outcome in cases of nonreassuring fetal heart rate.

Primary skull lesions, albeit rare in the pediatric population, have been well described and classified. These lesions are usually benign and commonly present as a painless mass. The most common lesions are epidermoid, dermoid, and Langerhans cell histiocytosis. Cranial fasciitis, encountered less frequently, is usually not considered in this differential diagnosis. Given such few cases reported, it is commonly misdiagnosed preoperatively. The authors retrospectively reviewed data obtained in 4 patients with cranial fasciitis in whom the diagnosis was based on histopathological findings. In 2 patients the onset of the lesion was spontaneous. One patient had a lesion 4 months following a vacuum extraction and subsequent cephalohematoma formation. One patient developed a lesion following a previous craniectomy. Presentation, imaging studies, and histopathological findings were all reviewed and analyzed. All patients presented with a firm nontender mass. Radiological features included a lytic bone lesion with a mildly sclerotic margin, T1 isodensity, T2 heterogeneous hyperdensity, and heterogeneous enhancement. The enhancing portion was not bright on T2-weighted MR images, likely representing the fibrous component; the nonenhancing portion was bright on T2-weighted images, likely representing the myxoid matrix. Histopathological examination revealed proliferating fibroblasts in a myxoid matrix. Cranial fasciitis is a benign, painless but rapidly growing lesion of the skull mainly limited to the pediatric population. It is histologically similar to nodular fasciitis, a fibroblastic proliferation of varying size. These lesions are often related to trauma but can also be insidious or can develop at a prior craniectomy site. The appropriate clinical picture and distinguishing radiographic features may help to differentiate cranial fasciitis from other lesions of the skull allowing for earlier intervention.

To examine the relationship between physicians' instrument preference and obstetrical and neonatal outcomes.A retrospective cohort study comparing obstetrical and neonatal outcomes of second stage deliveries between obstetricians who prefer forceps (forceps/=90%) with obstetricians with no preference to forceps (either instrument90%) was completed using the McGill Obstetrical and Neonatal Database. Logistic regression analysis was used to obtain an adjusted odds ratio controlling for maternal, intrapartum and neonatal confounders.Two thousand and three hundred thirteen infants were delivered by 5 obstetricians who preferred forceps, and 9261 infants were delivered by 15 obstetricians with no instrument preference. Baseline characteristics were similar between the two groups. As compared to obstetricians who preferred forceps, obstetricians with no instrument preference had a higher rate of operative vaginal deliveries 1.5 (1.1-2.0), a higher cesarean section rate 2.5 (1.3-4.9) and a higher episiotomy rate in non-operative vaginal deliveries 3.4 (2.7-4.3). Infants delivered by obstetricians with no instrument preference were less likely to have significant bruising 0.3 (0.2-0.6) but more likely to have a cephalohematoma 3.0 (1.1-8.3).Physician instrument preference is an important determinant of outcomes that should be considered in studies evaluating instrumental deliveries.

Until very recently, no specific therapies have been demonstrated to improve outcome after spontaneous intracerebral haemorrhage (ICH). The STICH (surgical treatment for intracerebral haemorrhage) study showed no overall benefit from early surgery when compared with initial conservative treatment. In contrast, the stereotactic aspiration technique can be safely performed and in a uniform manner. Despite the reduction of ICH volume, no improvement in mortality and functional result was obtained. Endoscopy is a new therapeutic option for ICH with good results for hematoma removal. Based on these feasibility studies, a randomized control trial regarding this procedure would be required to assess the efficacy of this procedure. Due to the lack of benefit observed in the recent STICH trial, emergency surgical evacuation should be reserved for patients with large lobar haemorrhage, mass effect and rapidly deteriorating clinical condition.

Cephalohematomas in newborns are often managed nonsurgically and resolve within the first month of life. In cases of large hematomas (>7 cm) with delayed resorption and persistence over 4 weeks, these masses can often lead to complications of calcification, infection, or hyperbilirubinemia. We report a case of a 14-day-old child with a persistent, large, noncalcified cephalohematoma. After observation alone showed that the cephalohematoma increased in size, 100 ml of old blood was surgically evacuated on day 15 of life. The procedure required a small 1-cm incision and, unlike most large cephalohematomas evacuated after 1 month of observation, there were no signs of skull-deforming calcification observed. This case report presents the earliest evacuation of large noncalcified cephalohematomas in newborns ever reported in the literature, and suggests benefits of early surgical evacuation before 1 month of life.

BACKGROUND Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis. METHODS Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications. RESULTS Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05). CONCLUSIONS In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.

BACKGROUND Deformational plagiocephaly is cranial asymmetry caused by external forces on the skull. Deformational plagiocephaly is seen in 5% to 48% of healthy newborns. Incomplete uvular fusion, in contrast, is one of many uvular malformations. The incidence of all degrees of incomplete uvular fusion is approximately 1% in healthy children. Bifid uvula is a malformation that is often considered a microform cleft palate or a marker for submucous cleft palate. METHODS This is a retrospective study of patients with deformational plagiocephaly seen at the Upstate Cleft and Craniofacial Center between January 1, 2006, and September 30, 2011. Patients were identified by the International Classification of Diseases, Ninth Revision code for plagiocephaly. Seventy-nine patients were excluded with craniosynostosis and syndromic diagnoses. One hundred forty-six patients with deformational plagiocephaly were included in the study. Data were collected for sex, age at presentation, parity, multiple births, delivery, oligohydramnios, cephalohematoma, uterine abnormalities, fetal position, and intrauterine growth restriction. Clinical findings were collected including location of cranial flattening and uvular malformations. RESULTS Twenty-four of 146 patients with deformational plagiocephaly had incomplete fusion of the uvula ranging from complete bifid uvula to a notched uvular tip (16.4%). This association was statistically significant (odds ratio, 18; 95% confidence interval, 11.1-28.9). Most patients (62.3%) were male. We recorded primiparity (44.5%), multiple births (17.1%), vacuum-assisted delivery (6.2%), cesarean section (36.3%), oligohydramnios (4.1%), uterine abnormalities (2.1%), abnormal fetal position (3.4%), and intrauterine growth restriction (1.4%). Ten of the 24 patients with plagiocephaly and uvular malformation were seen for an initial consultation only in our chart system. Of the remaining 14 patients with follow-up, none had recorded signs or symptoms of velopharyngeal insufficiency. CONCLUSIONS The incidence of incomplete uvular fusion in infants with deformational plagiocephaly is 16.4%, which is significantly higher than the approximate 1% incidence reported in the general population. This is the first report of uvular malformation in the presence of deformational plagiocephaly.

While calcified cephalohematoma is eminently correctable, a clear description of indications for surgery and surgical techniques are currently lacking in the literature. In this paper we propose a simple classification and an algorithm for the management of cephalohematomas. Three patients were treated for large calcified parietal cephalohematomas. Craniectomy and cranioplasty were performed with excellent outcome. Cranioplasty was performed with the cap radial craniectomy technique in two patients and the flip-over bull's-eye technique in one patient. The literature was reviewed on this entity and an algorithm based on the timing of presentation, extent of calcification and type of calcified cephalohematoma is proposed. Aspiration and compressive dressings can be used for early, incompletely calcified cephalohematomas. Calcified cephalohematoma causing significant distortion of the calvarium requires surgical correction and is classified as Types 1 or 2 depending on the contour of the inner lamella. Type 1, with a normal contoured inner lamella, can be corrected by ostectomy of the outer lamella. Type 2 calcified cephalohematoma has a depressed inner lamella. Elevation of the inner lamella is necessary and the cap radial craniectomy technique can be used. We describe a novel technique, the flip-over bull's-eye techniques as an alternative technique for Type 2 lesions in selected patients. In conclusion, calcified cephalohematomas can safely be treated surgically with excellent outcome. It is hoped that this algorithm will serve as a useful and logical guide in decision making for the management of this condition.

Background: The objective of the present retrospective study was to clarify the clinical course, major pathogens, and other infections associated with infected cephalohematoma. Methods: From January 1978 to December 2003, records of all newborns were reviewed for evidence of an infected cephalohematoma, based either on local signs of infection or a diagnostic tap that yielded pus. Patients were divided into two groups: those seen in the early period (1978–1990) and in the late period (1991–2003). Results: Twenty-eight newborns with infected cephalohematoma were identified, 14 each in the early and late periods. The mean age at onset was 17.8 ± 13.9 days. The most common local findings were erythema (79%), increasing size of the hematoma (68%), and a fluctuant mass (46%), while fever (64%), poor appetite (39%) and irritability (18%) were the common systemic signs. Common laboratory findings included leukocytosis (82%) and an elevated C-reactive protein (61%). Escherichia coli was the most common pathogen (16 patients, 57%) and was isolated significantly more frequently in the late period (early period: 36%, late period: 79%, P

Resume Objectif Decrire les complications maternelles et neonatales liees aux accouchements par ventouse et les comparer a celles survenues apres voies basses spontanees. Materiel et methodes Une serie consecutive de 4 524 accouchements (3 679 voies basses spontanees et 845 accouchements assistes par ventouse soit 18,7 %) a ete analysee retrospectivement. Les grossesses multiples et prematurees ont ete exclues. Les taux de chaque complication ont ete compares entre les deux groupes. Pour l’analyse des complications maternelles, les principaux facteurs de confusion ont ete pris en compte par une regression logistique multivariee. Resultats Nous avons denombre 1 333 complications maternelles ( Conclusion Nous avons montre que l’utilisation de la ventouse etait en soi un facteur de risque de perinees complets et de cephalhematomes. Cependant, les faibles taux de complications graves plaident en faveur de son utilisation croissante.

After completing this article, readers should be able to: 1. Describe the delivery conditions that increase the risk for birth trauma. 2. Explain why subgaleal hemorrhage can be a medical emergency. 3. Delineate the common presenting findings of traumatic intracranial bleeding. 4. Describe the risk factors for brachial plexus palsy. 5. Differentiate facial nerve palsy from congenital palsies and hypoplasia of the depressor anguli oris muscle. Birth injuries are sustained during the labor and delivery process. They can be divided into those due to physical trauma during the birth process (traumatic birth injury) and those due to lack of oxygen (hypoxic-ischemic injury). These types of injuries can occur separately or in combination. This review focuses on the diagnosis and management of traumatic birth injuries. Traumatic injuries often are the result of a discrepancy between the size or position of the fetus in relation to the birth canal or an unusually rigid pelvis that has not adapted to the size of the fetal head. The reported rate of birth trauma from a 7-year review published in 1990 was 3.2%. Some injuries are avoidable, and with improvements in obstetric care, the frequency of birth injury as a cause for perinatal mortality has decreased over the past 25 years. Predisposing factors for traumatic birth injury are listed in Table 1. Macrosomic fetuses, including those from poorly controlled diabetic pregnancies, represent a particularly high-risk group for birth injury. However, predicting which macrosomic infants will be injured during the birth process is difficult. Injuries also are more frequent with instrumented vaginal deliveries. Use of forceps has been associated with facial nerve and brachial plexus injuries, skull and facial fractures, and intracranial hemorrhages. Ocular injuries, including fracture of the base of the orbit, intraorbital hemorrhage, corneal laceration, and breaks in Descemet’s membrane with corneal opacification, as well as dislocated nasal …

Cerebral hematoma described as the bleeding into the cerebrum leads to an expanding mass of blood that damages surrounding neural tissues. It is a very rare clinical finding of congenital hypofibrinogenemia. In this case study we are reporting a 5-year old boy with massive epidural hematoma and recurrent cephalohematoma as a result of minor trauma.

Background: Although the majority of birth injuries are minor and often unreported, occasionally birth injuries may be so severe as to be fatal or leave the child with a permanent disability or even death.Objective: This study aimed to document the patterns and predictive factors of birth injuries in neonates presenting at the emergency center of a tertiary hospital in South west, Nigeria. Patients And Methods: This was a cross-sectional study of neonates who presented at the Olikoye Ransome-Kuti Children Emergency Center of the Lagos University Teaching Hospital between October and December 2016. All neonates admitted for treatment at the center for any clinical condition were included in the study after initial review or resuscitation/treatment for their primary complaint, and consent was obtained from their caregivers. The babies were examined by at least a senior resident and any abnormality documented. Any underlining medical conditions such as asphyxia and neonatal sepsis were properly investigated and treated. Statistical analyses were performed by chi-square, student's t-test, using SPSS version 20.0. P ≤ 0.05 was considered statistically significant. Results: A total of 134 neonates were reviewed during the study period with majority, 84 (62.7%), being males. The mean age at presentation was 65.2 ± 89.2 h (median 24 h). Caput succedaneum (22.2%) and subconjunctival hemorrhage (22.2%) were the most frequent injuries observed, while cranial nerve injury the least. One patient had multiple injuries (cranial nerve injury with fractures humerus). Conclusions: Overall prevalence and pattern of birth injuries in neonates presenting at our emergency center was consistent with various studies from other centers. Parity of the mother, significant maternal medical history, duration of labor, mode of delivery, and skill of attending personnel at delivery were significant factors associated with birth injuries

Craniosynostosis and its associated abnormalities can pose unique challenges to surgeons caring for these patients. Cephalohematomas, although rare, add to the complexities of managing a patient with craniosynostosis. Here, we present the case of a 4-month-old male infant with concurrent sagittal craniosynostosis and a calcified cephalohematoma who underwent an endoscopic-assisted strip craniectomy and management of the hematoma with good results.

We present a rare case of acute epidural hematoma in a newborn infant with congenital hydrocephalus that was related to Chiari II malformation. The hematoma was attributed to the application of excessive suction with a vacuum extractor during cesarean section. The clinical characteristics of neonatal epidural hematoma were analyzed after a review of 18 cases in the literature, and diagnosis and treatment are discussed with reference to the results. We propose that careful follow-up is essential in neonates with cephalohematoma, and that a computed tomography (CT) study should be performed immediately if an infant's head circumference is discovered to be enlarging or if the anterior fontanel bulges.

We present a neonate with cephalohematoma complicated by a linear skull fracture and Staphylococcus epidermidis meningitis. Clinicians, especially neonatologists, should be aware that a cephalohematoma in the newborn infant with a history of vacuum-assisted delivery could be the origin or trigger point of the infection either as sepsis, meningitis or osteomyelitis. The utmost importance of screening studies should be emphasized in order to be aware of the pathogenic potential of cephalohematomas.

Dermoid cysts are ectodermal inclusion cysts with epithelial lining in the subcutaneous tissue along the lines of embryonic fusion. Encephalocele, meningocele, hemangioma, lipoma, cephalohematoma, and sebaceous cyst are the differential diagnoses. The differentiation between them is essential for effective management to proceed. Obtaining a reliable history, completing a careful physical examination, and accurate radiographic documentation represent the first steps. We report a case of a naso-orbital dermoid cyst that was transilluminant, thus masquerading as a meningocele.

An index of transient mechanical birth trauma (TMBT), consisting of the presence or absence of molding, cephalohematoma, subconjunctival hemorrhage, body bruising, facial bruising, petechiae, forceps marks, diminished arm movements, and sensitivity to sudden position changes, was measured on a convenience sample of 196 healthy newborns. Six dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and other newborn measures also were assessed. Vaginally delivered newborns had more TMBT than those delivered by cesarean section and of newborns delivered vaginally, macrosomics had more TMBT than nonmacrosomics. TMBT positively correlated with range of state, individual reflex items of resistance to left and right arm movement, predominant state during the NBAS exam, and time to complete the NBAS exam. TMBT negatively correlated with newborn state instability and 1-and 5-minute Apgars. The results supported the measure’s validity and are discussed in terms of implications for practice and further research to explore TMBT’s usefulness.

Spontaneously infected cephalohematomas are rare occurrences; only five cases have been reported previously. Uninfected cephalohematomas are common and usually resolve without treatment. However, physicians should be aware that cephalohematomas are potential sites for infection and may require aspiration for diagnosis and treatment. Untreated infected cephalohematomas may lead to osteomyelitis, epidural abscess, or subdural empyema. We present a case of a spontaneously infected cephalohematoma with an associated osteomyelitis which was successfully managed with drainage and long-term antibiotics. A review of the literature is also presented.

A newborn presented on day 15 of life with an epidural hematoma, extending through a diastatic sutura squamosa in an external cephalhematoma. There was no skull fracture. The cephalhematoma was punctured twice with 24-h interval, reducing both the cephalhematoma and the epidural component. In the absence of neurological signs or symptoms, aspirating a cephalhematoma to evacuate the communicating epidural hematoma in a newborn infant may avoid more invasive surgical intervention.

We report on a case of gastrointestinal hemorrage (GIH) as first haemophilia A haemorrhagic presentation in a neonate with associated enlarged mesenteric artery. Although in the neonatal period acquired coagulation disorders are relatively common, congenital haemophilias might be diagnosed within this period. The majority of coagulation centres record women in child bearing age with a known history of haemophilia. Follow up during pregnancy and delivery is generally performed. However, it is not uncommon that newborns with congenital coagulopathies are diagnosed only after the first bleeding episode. Mucosal bleedings are commonly associated with von Willebrands disease, and factor XIII deficit rather than factor VIII or factor IX deficiencies. Cases of mucosal bleeding have been described in haemophilia A patients following exposure to factor VIII when inhibitor (anti-FVIII antibodies) titres rise. First manifestations of haemophilia can be birth-trauma related, in particular intracranial haemorrage (ICH) or extracranial bleeding (scalp haemorrhages, cephalohematoma, subgaleal haematoma). The risk is higher when normal vaginal delivery is not possible and C-section or vacuum delivery is performed. In severe haemophilia A (factor VIII level< 0-0.01 U mL), patients may present with haemorrhagic symptoms before the first year of age. The reasons for this include bleeding at the umbilical stump, large haematoma secondary to vitamin K administration or at site of puncture (e.g. heel pricks) and postcircumcision. Out of all classical bleeding for congenital coagulopathies, GI bleeding has been reported up to 38% with factor X deficiency. GIH and epistaxis are the most common spontaneous symptoms in acquired von Willebrand s disease. The incidence of GIH as early haemophilia manifestation in young children is unknown. Only two other cases of haemophilia B [1,2] and one case of haemophilia A are reported [3]. Non-haematological causes of GIH in newborns have been described as consequences of necrotic enterocolitis (NEC) or in association with intestinal malformations. A male neonate, of Nigerian origin, 2 days old was admitted to the Intensive Care Unit of Our Lady s Children’s Hospital, in Dublin. His body weight was 3260 g at delivery after 42 weeks of gestation. Apgar scores were nine after 1 and 5 min. Previous offspring included two healthy females and a healthy 5-year-old boy without bleeding history. No family history of haemophilia was recorded. No genetic counselling or investigation for haemophilia had ever been carried out. An extended query, into a multigenerational maternal history, with particular attention to the mother s male siblings, cousins, was carried out and was negative. On day 2 after birth, the baby had four intermittent episodes of severe haematemesis and enterorrhagia. A bottle-feed had been given a few hours before these events. The patient developed cardiac shock: blood pressure 60/ 30 mmHg, pulse 173/min, temperature 36.1 C, oxygen saturation 94% on room air, respiratory rate 90/min. The full blood count showed: haemoglobin 5.4 g dL, haematocrit 15.7%, platelet count 148 · 10 lL, white cell count 8.6 · 10 lL. Intubation was required. Coagulation studies before FFP administration showed a PT of 12.0 s, and an APTT of 70 s. A red cell paedipack (20 mL kg), fresh frozen plasma (50 mL), and albumin 4.5% (40 mL) were transfused. NEC was suspected and the patient was commenced intravenously on antibiotic therapy (penicillin, gentamicin and metronidazole). Vitamin-K 1 mg i.v. and omeprazole i.v. were also administered. There was no past medical Correspondence: Dr Andrea Piccin, Irish Blood Transfusion Service, James s Street, Dublin 8, Ireland. Tel: +353 (0) 1 432 2812; fax: +39 049 875 0693; e-mail: apiccin@gmail.com

Cephalohematomas following birth normally resorb within the 1st month of life. In cases of prolonged resorption, over greater than 1 month, cephalohematomas typically begin to calcify. We report the case of a 3-month-old child with a persistent, large cephalohematoma that did not calcify. After observation alone failed to demonstrate a decrease in the size of the hematoma, 30 cm3 of old blood was aspirated, and the patient's head was wrapped. Unlike calcified cephalohematomas, this noncalcified lesion did not require open surgical intervention. A treatment protocol for cephalohematomas is presented.

Neonatal subgaleal hematomas (SGHs) are infrequent but may be underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock have caused death in 20–60% of newborn infants [1]. SGHs are mostly caused by vacuum delivery, and sometimes by neonatal coagulopathy. We report a case of a newborn who suffered from severe SGHs and anemia on the third day after delivery. A 26-year-old, gravida 1, para 0, mother, who had regular prenatal care at our hospital with no abnormal laboratory data or abnormal sonographic findings, was admitted to our delivery room at 38 weeks’ gestation for labor. The first and second stages of labor took about 15 hours and 6 hours, respectively. Vacuum extraction was used because of maternal exhaustion and prolonged second stage. Third-degree perineal laceration was found after delivery. The male baby was active and irritable after delivery, with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. A small caput succedaneum occurred as usual, on the posterior fontanel. Unfortunately, the caput succedaneum seemed to progress until a big cephalohematoma was noted on the third day of delivery. It crossed the midline (sagittal suture) and covered the whole occipital area down towards the posterior neck, even though we packed it with an elastic cap. It continued to grow toward the anterior neck region and then the cheek. Patches of ecchymosis were noted over the eyelids (Figure), anterior neck, and ears. Because of this unusual appearance

A 4-day old neonate presented with a midline swelling located on the back of its head. The two most likely causes of the swelling were cephalohematoma, which is self-limiting and carries a benign prognosis, and encephalocele, often associated with central nervous system malformations. Evaluation with magnetic resonance imaging (MRI) revealed a subperiosteal blood collection with intact underlying structures, establishing the diagnosis of a cephalohematoma. This is the first report to show the value of MRI in distinguishing between an occipital cephalohematoma and an encephalocele.

Some special problems of neonates are related to the adverse effects of delivery such as birth trauma with high mortality and morbidity. The aim of this study was to determine the incidence of birth trauma and related risk factors in a referral hospital in Rafsanjan, a city in the south of Iran.In this cross-sectional study, we reviewed medical records of all 3340 live neonates that were born between March 2004 and March 2005 at Nicknafs maternity center. Special questionnaires of study were completed and data was analyzed.Among all neonates, 0.8% of them had birth trauma. The most common types of trauma were cephalohematoma 37.03%, massive hematoma 37.03%, and clavicular fracture 11.2%. The incidence of brachial plexus injury and clavicular fracture was higher in macrosomic neonates, whereas cephalhematoma, skin injury and massive hematoma were more prevalent in microsomic neonates. Neonatal birth trauma was more frequent in vaginal delivery than cesarean section (1.3% vs 0.1%, p = 0.0001). However, the incidence of birth trauma in instrumental delivery and normal vaginal delivery were similar (2.8% vs 1.3%, p = 0.303).The incidence of birth trauma in this region is 0.8% and birthweight and normal vaginal delivery are strong predictors for birth injuries.

Advances in neonatal care now enable more infants to be kept alive despite clear clinical evidence of inevitable or imminent death on a life-support system. It is therefore no longer acceptable to the society that a patient is left to die in the hospital, without any form of treatment or intervention. We report a case of severe birth asphyxia, hypoxic-ischemic encephalopathy, neonatal seizures and left cephalohematoma. In spite of initial successful resuscitation, the infant could not survive until all possible methods of treatment were exhausted. This case illustrates one of many examples of the process involved in dealing with ending of life decision in a condition considered as futile.