fracture due to truma during birth

1. fracture due to truma during birth Prepared by : Ayda khader sept .2017

2. Fractures are rare, the most commonly affected bones are : • clavicle, • humerus, • femur • skull With all such fractures, a ‘crack’ may be heard during the birth.

3. clavicle fracture the most frequently bone injure in the neonate during birth and most often is an unpredictable unavoidable complication of normal birth. The infant may present with pseudoparalysis.

4. Fractures can occur with shoulder dystocia or a vaginal breech birth, or if the baby is macrosomic. • The affected clavicle is usually the one that was nearest the maternal symphysis pubis. • Brachial plexus and phrenic nerve injuries should be excluded in the affected baby.

5. Humerus • Midshaft fractures can occur if with shoulder dystocia or during a vaginal breech birth the extended arm is forced down and born. Femur • Midshaft fractures can occur during vaginal breech birth if the extended legs are forced down and born. bone.

6. An X-ray examination can usually confirm the diagnosis. • The baby requires careful handling to avoid further pain, and mild analgesia, such as paracetamol may be required • Fractures of the clavicle require no specific treatment. • To immobilize a fractured humerus, place a pad in the axilla and firmly splint the arm with the elbow bent across the chest with a bandage, ensuring respirations are not embarrassed. • Immobilize a fractured femur using a splint and bandage • union of a fractured clavicle usually occurs in 7–10 days, while the humerus and femur take 2–3 weeks.

7. Skull • rare, these fractures, linear or depressed • may occur during prolonged or difficult instrumental births. • There may be no signs but an overlying cephalhaematoma, or signs of associated complications such as intracranial haemorrhage or neurological disturbances, may suggest a fracture's presence. • X-ray examination can confirm the fracture • skull fractures usually heal quickly with no sequelae

8. Convulsions • seizure/fit is a sign of neurological disturbance, not a disease, and is a medical emergency • convulsions present quite differently in the neonate • more difficult to recognize than those of later infancy, childhood or adulthood • Convulsive movements should also be differentiated from the benign bilateral or localized jerking that occurs normally in neonatal sleep, particularly rapid eye movement sleep

9. newborn brain is still developing, its function is immature and there is an imbalance between stimulation and inhibition of neural networks • Abnormal, sudden or repetitive movements of any part of the body that are not controlled by repositioning or containment holds require investigation

10. :classify the convulsion as I -Subtle convulsionsfound in term and pre-term babies, include • movements such as blinking or fluttering of the eyelids, • chewing and cycling movements of the legs • Apnoea • may or may not be associated abnormal (EEG) activity

11. II - Tonic convulsions • Focal tonic convulsions are more common in pre-term babies • there is extension or flexion of a limb • asymmetric postures of the body or neck • Abnormal brain activity ,EEGcan be detected • Generalized tonic convulsions • are more common than focal tonic convulsions, • baby sustains a rigid extended posture • similar to decerebrate posturing, • that is not usually detected on EEG

12. III - clonic convulsionsas focal or generalized more common in term babies • Focal clonic convulsions • unilateral, affecting the face, neck or trunk or upper or lower extremity whereas multifocal clonic convulsions affect several areas of the body that jerk asynchronously and migrate. • The movements are slow (one to three jerks per second), rhythmic • most likely to be associated with EEG activity.

13. IV - Myoclonic convulsionsare the least common and affect term and pre-term babies • differ from clonic convulsions • they are faster • are not associated with EEG activity. • Focal myoclonic convulsions affect the upper body flexor muscles. • Multifocal myoclonic convulsions affect several parts of the body with asynchronous jerks. • Generalized myoclonic convulsions affect the upper and sometimes lower extremities with jerking flexion movements

14. During a convulsion the baby may have: • tachycardia, hypertension, raised cerebral blood flow • raised intracranial pressure, predispose to serious complications. • convulsions may be difficult to recognize, • The underlying conditions that may result in a convulsion are classified as central nervous system, metabolic, other and idiopathic conditions • Convulsions may be acute, recurrent or chronic

15. causes of neonatal convulsions Central nervous system • Intracranial haemorrhage • Intracerebral haemorrhage • Hypoxic-ischaemic encephalopathy • Kernicterus • Congenital abnormalities Metabolic • Acquired disorders of metabolism • Hypo- and hyperglycaemia • Hypo- and hypercalcaemia • Hypo- and hypernatraemia • Inborn errors of metabolism

16. Other • Hypoxia • Congenital infections • Severe postnatallyacquired infections • Neonatal abstinence syndrome • Hyperthermia

17. Immediate treatment necessitates obtaining assistance from a doctor • ensuring that the baby has a clear airway and adequate ventilation • Gentle oral and nasal suction may be required to remove any milk or mucus • The need for intravenous access should be assessed • Any necessary handling must be gentle • nature of the convulsion is documented • the pharmacologic control of the convulsion] • (phenobarbital and phenytoin )most common drug

18. Parents • Trauma during birth are unexpected complications and parents may be shocked and anxious, and perhaps find themselves in a crisis situation • not all parents experience such feelings and some can adapt quickly to their baby's condition • One of the most important aspects of caring for the parents is in relation to communication • All parents are entitled to be given information about their baby's condition, treatment and care in ways that are considered best practice • The baby must be valued as a baby • involvement in their baby's care is essential and the family-centered care/partnership with parents approach

19. The baby must be valued as a baby by: • using the baby's name • not predicting the future • when sharing information, keeping the baby with the parents if possible.

20. The parents and family must be respected by: • facilitating parental support and empowerment • acknowledging cultural and religious differences • listening to their views and taking their concerns seriously • giving information honestly and sensitively using uncomplicated language • ensuring understanding and giving opportunities for questions • facilitating follow-up and providing further information when required