TRAUMA AND

CONGENITAL ANOMALIES

WHAT IS TRAUMA ?
Trauma means damage or injury
When?

During delivery

Infant may also be damaged by the

person conduting the delivery

WHICH INFANTS ARE AT

INCREASED RISK OF TRAUMA?
Preterm infants with delicate tissues

that are easily damaged.

Large infants where there is
difficulty delivering the head and
shoulders.
Malpresentation, e.g. breech
delivery where the infant has to be
manipulated.

Which Infants/
Forceps or vacuum delivery where

traction or suction is applied to the

head.
Unassisted deliveries where the
infant may fall after delivery.
Precipitous deliveries when the
infant is delivered very fast.

WHAT ARE THE MAJOR TYPES

OF TRAUMA?
Caput ( or caput succedaneum)
Cephalhaematoma
Subaponeurotic haemorrhage
Facial palsy
Brachial palsy
Bruising
Fractures
Lacerations

WHAT IS CAPUT?
Oedema of the presenting part

caused by pressure on the

presenting part during a vaginal
delivery.
It will disappears during the first 48
hours after delivery.
Chignon: more sever caput, often
with damage to the skin.

WHAT IS A CEPHALHAEMATOMA?
A collection of blood under the

periosteum of the parietal bone.

Unilateral or bilateral, localized
swelling.
Appears within hours of delivery as
a soft, fluctuant swelling on the side
of the head.

What is/
Never extend beyond the edges of

the bone.
Never crosses suture lines.
Bleeding is caused by damage to
capillaries under the periosteum of
the parietal bone.

TREATMENT OF A
CEPHALHAEMATOMA
Usually small and need no treament.

Reabsorption of blood

jaundince may require

phototherapy.
It may take up to 3 months before the
cephalhaematoma disappears.
A bony ridge may from at the edge of the healing
haematoma.
Never aspirate or drain.

TREATMENT OF A
SUBAPONEUROTIC
HAEMORRHAGE
Requires emergency treatment.
Replace the blood.

Konakion 1 mg by I M / I V, assist

the liver to replace clotting factors.

FACIAL PALSY
Muscle weakness of one side of the

face due to trauma to the facial nerve.

The affected side of the face droops.
Unable to close the eye tightly on the

side

Facial/
When crying

the mouth is
pulled across to the normal side.

Usually recovers spontaneously in

a few days or weeks.

BRACHIAL PALSY / ERBS PALSY

Usually happen in large and born at

term with difficulty in delivering the

shoulders.
Infant does not move one arm due
to weakness at the shoulders and
below.

Brachial/
The arm is fully extended, rotated

inwards and held beside the body

(the porters tip position).
Asymmetrical moro reflex.
No tenderness, pain or swelling of
the arm unless
fracture.

TREATMENT OF BRACHIAL
PALSY

Flex the elbow and shoulders a few

times a day to prevent contractures

developing.
If the arm is not better by 6 weeks
no hope of spontaneous
recovery; reffered for further
investigation.

WHAT CAUSES BRUISING ?

Common in difficult deliveries, breech

delivery in a preterm infant.

The bruise is due to bleeding into the
skin and muscle caused by the rupture of
small blood vessels.
Bruissing appearing after 1st day is
serious and suggests a bleeding problem
or intentional trauma / battering.

WHAT FRACTURES ARE SEEN IN

THE NEWBORN INFANT ?
The clavicle

most common.
Fracture of the humerus, femur and
skull are fortunately uncommon.
When the bone is palpated
bony
crepitus.
Confirm by X-Ray.

HOW ARE FRACTURES

TREATED?
Fracture of the clavicle needs no treament

and heals well.

Fracture of the humerus
immobilized.
Fractureof the femur
gallows traction.
Paracetamol can be given.
Depressed fracture of the skull
surgical.

WHAT IS THE MANAGEMENT OF

LACERATIONS ?

Usually made during a caesaren

section.
Small cuts
Large cuts
asap.

closed with strapping.

must be sutured,

WHAT IS A CONGENITAL
ABNORMALITY ?
An abnormality in body structure
that is present at birth.
Some internal abnormalities can
sometimes only be diagnosed
weeks or months after birth.
About 3% of infants have a
congenital abnormality.

THE MAIN CAUSES OF

CONGENITAL ABNORMALITIES
ARE :
Chromosomal abnormalities,e.g.

Down Syndrome.
Gene abnormalities. These are
often inherited from either one
parent or both parents.
Teratogens, e.g. Alcohol

The main/
Fetal infections,e.g. Rubella.
Maternal diabetes.
Compression of the fetus due to

oligohydramnion.
Unfortunately the cause of many
congenital abnormalities is not
know.

WHEN SHOULD YOU ANTICIPATE

A CONGENITAL ABNORMALITY ?
There is a past or family history.
Maternal illness in the first trimester.
Maternal diabetes (poorly

controlled)
Consume excessive alcohol.

When should/
Maternal drugs in the 1st trimester (warfarin or

anticonvulsants).
Maternal

38 years.

Polyhydramnios or oligohydramnios.
Persistent breech presentation.
Twins, especially if they are indentical.
Underweight for gestational age infants.

HOW SHOULD YOU MANAGE

PARENTS OF AN INFANT WITH
CONGENITAL ABNORMALITIES ?
Speak to the parents together ( if

possible ).
The sooner the better.
Be honest., do not try to give all the
details at once.
Be kind and tell them that you care.

How should/
Be understanding, be patient.
Do not make them feel that it is

their fault that the infant is

abnormal.
Allow them to see, hold their infant.
Allow them to speak and ask
questions.

How should/
Try to be optimistic and encouraging

about the prognosis.

Speak about the risk of an abnormal
infant in following pregnancies.
Give details of the future management
of the infant.
Always keep the infant comfortable.

WHAT SHOULD YOU DO IF AN

INFANT HAS EXTRA FINGERS ?
Often the mother/father also had this

problem at birth.
Tied off with a piece of cotton or
surgical silk.
If contains bone or cartilage (rare)
ass. With other major congenital
abn. Reffered for further investigation.

CLUBBED FEET AN
MANAGEMENT
Mostly are slightly twisted inward due

to position of the fetus

just gentle
pressure.
Some are twisted inward and cannot
be turned into a normal position
clubbed feet!
The cause maybe familial or
oligohydramnios.

Clubbed feet/
Reffered to an orthopaedi clinic

within a few days of life.

Maybe need strapping or serial
plaster of Paris Casts. May also
need a minor operation.

DISLOCATED HIPS
The hips of all infants should be

examined after birth (Barlows test).

Detect is the any dislocated or

dislocatable joint.
Confirmed by USG or X-Ray.

UNDESCENDED TESTES
By term, both testes

descended into the scrotum.

Many undescended testes will move into the scrotum
spontaneously during the first 3 months.
Undescended testes persist
operation at about 1
year.
Bilateral undescended testes
risk of infertility.

HYPOSPADIAS
The urethral opening is on the underside of the penis

or at the base of the scrotum.

Can be corrected surgically when the infant is a few
month old.
Must not be circumcised as the foreskin may be use to
correct the urethrea.
The sexual function will be normal.

WHAT ARE AMBIGUOUS

GENITALIA ?

The external sex organs are not

typically male or female.

Should all be reffered urgently.

FLUID HERNIA / HYDROCOELES

The scrotum transilluminates very

well. (Fluid only not bowel)

Most disappear after a few months
and need no treatment.
If they are very big, maybe require
surgical correction at about 3 months
old.

MANAGEMENT OF A CLEFT LIP

AND OR CLEFT PALATE
The lip usually repaired at about 3

months but the cleft palate is

repaired later.
The infant with cleft palate may
need cup or nasogastric feeds;
must be referred within a day or 2
to a plastic surgery clinic.

OESOPHAGEAL ATRESIA
Polyhydramnious always suggest oesaphageal

atresia.
Aware if infant has excessive saliva.
D/ is confirmed by the inability to pass a
nasogastric tube.
This infant must be nursed head up.
Nill by mouth surgical !!

EXOMPHALOS/OMPHALOCOEL
E
No abominal wall around the base of

the umbilical cord.

The abnormality should be covered
with sterile gauze.
Surgical emergency

WHAT CLINICAL SIGNS WOULD

SUGGEST A CONGENITAL HEART
ABN.?
Central cyanosis, not corrected by

100% O2.
A heart murmur.
Absent femoral pulses.
Signs of heart failure: hepatomegaly,
excessive weight gain, oedema,
respiratory distress.

MENINGOMYLOCOELE
A major abn. Of the spine; usually in

the lumbar area.

A flat area of the spinal cord is
exposed on the skin.
Covered with a sterile gauze.
Refers urgently.

DOWN SYNDROME /
MONGOLISM
Caused by an extra number 21

chromosome / trisomy 21. Is about 1 in

600. The older the mother the higher is
the risk.
A number of recognizable signs :
1. A typical flat face with downward
slanting eyes and a wide nasal
bridge.

Down syndrome/
2. The head is round and the back of
the head / occiput is flat.
3. The tounge appears big and
frequently sticks out.
4. The ears are small.
5. A single palmer crease.

Down syndrome/
6. Hypotonic.
7. Feeds poorly.
They often have major congenital
abn. e.g. Heart defects and duodenal
atresia.
Mentally retarded, develop slowly.