29 - Birth Injuries

Abstract

Over the last few decades, the number of birth injuries as a cause of neonatal death has dramatically declined as a direct result of improvements in prenatal care and obstetric techniques. However, despite a reduction in related mortality rates, birth injuries still represent a major cause of neonatal morbidity and neonatal intensive care unit admissions. Birth injuries may be avoidable or unavoidable, and they can occur even with skilled and competent obstetric care. Factors that predispose an infant to birth injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, abnormal presentation, and certain operative deliveries, particularly vacuum and forceps extraction. The fetus may also sustain injury, including death, secondary to maternal trauma. After a difficult birth, a thorough physical examination of the infant is critical to identify any injury that may have occurred. The clinician should consider the broad spectrum of birth injuries within the differential diagnosis of neonatal clinical disorders. Although many injuries are mild and self-limited, others are serious and potentially lethal. In addition to assuring timely institution of treatment when indicated, recognition and documentation before discharge from the hospital will help avoid inappropriate suspicion of inflicted injury (child abuse) at a later date.