Neonatal Trauma Research Articles

Neurosensorimotor Reflex Integration, Myofascial Release, & Neuro-Developmental Treatment In Children With Cerebral Palsy Athetoid Diplegi: Case Report

Cerebral Palsy (CP) is a disorder caused by brain damage that results in impaired motor and intelligence function. The causes of CP can be divided into three parts: prenatal, natal, and postnatal. The causes of the Prenatal period are maternal infections, hypoxia or ischemia, and placental abnormalities. The causes of the Christmas period are Birth Trauma, Birth Asphyxia, and premature birth. The causes of the postnatal period are neonatal infections, head trauma, and ongoing medical conditions. Measurements were carried out by palpating muscle tone and primitive reflexes with blank gross motor ability reflexes of children with GMFM. The therapy administration for 4 times has not significantly affected muscle tone with muscle palpation at T1, T2, T3, T4 with hypertonic results. Pathological primitive reflexes with reflex blanks on T1, T2, T3, T4 with positive results of ATNR, Cross extensors, graps, Neck righting, Body righting, Optical righting, Labiryn Righting. Gross motor ability with GMFM at T1, T2, T3, T4 with a yield of 34.4%

Management of neonatal head injuries: A retrospective cohort study

AbstractAimThe aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years.MethodsMulticentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021.ResultsA total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates.Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (<48 h), and 126/492 (25.6%) were admitted.Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT.ConclusionSevere neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries.

The effect of birth-weight and instrumental delivery on neonatal birth trauma in Ethiopia: systematic review and meta-analysis

Birth trauma is one of the most common causes of neonatal mortality in a resource-limited country. However, there is no national evidence on the magnitude and associated factors of neonatal birth trauma in Ethiopia. Therefore, this study aimed to estimate pooled prevalence of neonatal birth trauma and its association with birth-weight and instrumental delivery in the Ethiopian context. PubMed, Scopus, CINAHIL, Cochrane library and Google Scholar were used to search significant articles. Suitable search terms were developed and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Ethiopia and published in English language. Critical appraisal was conducted by using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Heterogeneity across the included studies was evaluated by using the inconsistency index (I2) test. STATA™ version 11 software was used to conduct the meta-analysis. A total of 7 studies with 4063 study participants were included in this systematic review and meta-analysis. The overall pooled prevalence of neonatal birth trauma in Ethiopia was 13.4% (95% CI; (10.86, 15.95). instrumental delivery and ABO large birth weight were significantly associated with the prevalence of neonatal birth trauma. The national pooled prevalence of neonatal birth trauma was found to be high in Ethiopia. Instrumental delivery and large birth-weight were significantly associated with neonatal birth trauma in Ethiopia. Thus, it is better to give strong obstetric care during the use instrumental delivery.

Impact of planned delivery mode on neonatal outcomes and costs in twin pregnancies in Kenya

BackgroundTwin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical. ObjectiveTo evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya. Study DesignThis retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category. ResultsThe study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15–0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82). ConclusionPlanned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.

Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study

BackgroundMild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds.MethodsThis register-based study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria (fasting 5.1–5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8–8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome – a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality – was analysed using multivariate logistic regression.ResultsThe risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71–1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60–1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27–0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18–0.57).DiscussionThe risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis.

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.

A 30 YEAR (1991-2020) RETROSPECTIVE MORTALITY REVIEW OF GIRAFFIDS (GIRAFFA SPP. AND OKAPIA JOHNSTONI) IN MANAGED CARE.

Identifying common causes of mortality in zoo giraffe (Giraffa spp.) and okapi (Okapia johnstoni) provides an opportunity to help improve welfare and population management for these endangered species. Mortality reports from 1,024 giraffe and 95 okapi in zoos were compiled from the Species 360 Zoological Information Management Software (ZIMS) utilizing the Morbidity & Mortality Analysis tool. Thirty years of mortality reports (1991-2020) were evaluated to help identify trends and evaluate the impacts, if any, of changes over time in husbandry and management practices. The most common causes of death for giraffe from 1991 to 2015 were neonatal issues (234/845, 27.7%), trauma (213/845, 25.2%), noninfectious disease (190/845, 22.5%), and infectious disease (188/845, 22.2%). In comparison, the most common causes of mortality for giraffe from 2016 to 2020, were noninfectious disease (78/179, 43.6%), trauma (39/179, 21.8%), neonatal issues (39/179, 21.8%), and infectious disease (17/179, 9.5%). The most common cause of death for okapi from 1991 to 2015 were neonatal issues (29/64, 45.3%), infectious disease (13/64, 20.3%), noninfectious disease (11/64, 17.2%), and trauma (10/64, 15.6%). In comparison, the most common cause of death for okapi from 2016 to 2020 was noninfectious disease (15/31, 48.4%), neonatal issues (8/31, 25.8%), and infectious disease (5/31, 16.1%). The results suggest that zoo giraffids have had a relative decrease in mortality from infectious diseases in recent years, whereas death from noninfectious causes has increased significantly. Trauma-related giraffe mortalities and neonatal mortality in both giraffe and okapi, although decreasing in prevalence between time periods, continue to be important causes of death in zoos. This is the first descriptive mortality review for the Giraffidae family and provides data on potential giraffe and okapi health issues that zoos could proactively address.

Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked.

Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked.

Incidence of Trauma during Birth to Neonates Born to Mothers with Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance that occurs during pregnancy. The incidence of GDM has been on the rise and is a significant cause of various consequences for both the mother and infant. Such consequences include birth trauma. Factors such as shoulder dystocia and fetal macrosomia can increase the incidence of birth trauma. Additionally, GDM is a major cause of fetal macrosomia, influencing the intrapartum delivery method. This study aims to investigate the incidence of birth trauma in mothers with and without GDM. A total of 10,865 patients from King Hamad University Hospital (KHUH) were included, and their files were then further stratified only to include neonates with evidence of birth trauma. A total of 64 patients were found to fit the inclusion criteria. The study looked at GDM status, gestational age, birth weight, length, head circumference, mode of delivery, presentation of the baby before delivery, assistance during delivery, and maternal/neonatal trauma. Maternal trauma rates were found to be statistically significant within the population of the Kingdom of Bahrain. An increased incidence of maternal trauma was observed in the non-GDM group, with 56.3% of the patients requiring an episiotomy or having a complication of a vaginal laceration. Regarding the incidence of birth traumas in the GDM group, they presented most commonly with cephalohematoma or Erb’s palsy, whereas the non-GDM group most commonly presented with cephalohematoma. The incidence of birth trauma due to GDM has seldom been researched in the existing literature. However, it has been noted that factors such as macrosomia can increase the likelihood of birth trauma. The general incidence of neonatal birth trauma has been reported to be 2.7%, which is reassuring; however, it is essential to investigate further the effect of GDM on the rates of birth trauma using large population cohorts.

Association of Continuous Glucose Monitoring Metrics With Pregnancy Outcomes in Patients With Preexisting Diabetes.

Continuous glucose monitoring (CGM) improves maternal glycemic control and neonatal outcomes in type 1 diabetes pregnancies compared with self-monitoring of blood glucose. However, CGM targets for pregnancy are based on expert opinion. We aimed to evaluate the association between CGM metrics and perinatal outcomes and identify evidence-based targets to reduce morbidity. This was a retrospective cohort study of pregnant patients with type 1 or 2 diabetes who used real-time CGM and delivered at a U.S. tertiary center (2018-2021). Multiple gestations, fetal anomalies, and early pregnancy loss were excluded. Exposures included time in range (TIR; 65-140 mg/dL), time above range (TAR), time below range (TBR), glucose variability, average glucose, and glucose management indicator. The primary outcome was a composite of fetal or neonatal mortality, large or small for gestational age at birth, neonatal intensive care unit admission, hypoglycemia, shoulder dystocia or birth trauma, and hyperbilirubinemia. Logistic regression estimated the association between CGM metrics and outcomes, and optimal TIR was calculated. Of 117 patients, 16 (13.7%) used CGM before pregnancy and 68 (58.1%) had type 1 diabetes. Overall, 98 patients (83.8%) developed the composite neonatal outcome. All CGM metrics, except TBR, were associated with neonatal morbidity. For each 5 percentage-point increase in TIR, there was 28% reduced odds of neonatal morbidity (odds ratio 0.72, 95% CI 0.58-0.89). The statistically optimal TIR was 66-71%. Nearly all CGM metrics were associated with adverse neonatal morbidity and mortality and may aid management of preexisting diabetes in pregnancy. Our findings support the American Diabetes Association recommendation of 70% TIR.

How do parents frame their engagement experience in early intervention? A grounded theory study

Purpose Parent and therapist engagement and partnership are critical in early intervention physiotherapy and occupational therapy for infants with cerebral palsy to improve outcomes. The main aim of this study was to understand how parents perceive their engagement experience in early intervention over time. Methods Grounded theory methodology was used. Twenty parents of diverse backgrounds participated in 22 interviews (including some repeated longitudinally) to reflect on their engagement experience within the context of early intervention community services provided in the UK NHS. Results The findings highlight how parents’ perspectives of their engagement in EI change according to critical circumstances, including their preceding neonatal trauma, the at-risk CP label, firmer diagnosis of CP and their child’s response to intervention. We theorise that this disrupted transition experience to parenthood becomes part of parental framing (or sense-making) of their engagement in EI. Overlapping frames of uncertainty, pursuit and transformation capture and explain nuances in parents’ engagement patterns within EI over time. Conclusion This theorising has implications for early intervention therapists in how they engage in the lives of families and partner with parents to support healthier parental transition, wellbeing and subsequent improved infant outcomes.

Determinants of mechanical birth trauma among live born neonates admitted at University of Gondar comprehensive specialized hospital neonatal intensive care unit, northwest Ethiopia: A case-control study

Background: The occurrence of birth trauma varies according to the fetal factors, labour and delivery processes and maternal factors. However, there is limited data on the possible factors associated with neonatal birth trauma in our setup. This study aimed to identify the associated factors of birth trauma among live-born neonates in the University of Gondar Comprehensive Specialized Hospital (UoGCSH) Neonatal Intensive Care Unit.&#x0D; Method: An unmatched case-control study was conducted among live-born neonates admitted neonatal intensive care unit of UoGCSH over a year from February 1, 2020 to February 1, 2021 G.C. Data was analyzed by SPSS version 20. Descriptive statistics and adjusted Odds Ratio (AOR) with a 95% confidence interval and a p-value of &lt;0.05 was used to identify determinant factors.&#x0D; Result: A total of 300 neonates were included with 1:2 ratio of case and controls. The determinant factors of mechanical birth trauma were head circumference (AOR=1.76, 95% CI: 1.26, 2.46), instrumental delivery (AOR=10.65, 95%CI: 2.83, 40.04), malpresentation (AOR=6.31, 95%CI: 1.01, 40.08) and prolonged labour (AOR=1.45, 95%CI: 2.04, 4.49).&#x0D; Conclusion: Instrumental delivery, malpresentation, &gt;37cm head circumference, and prolonged duration of labour had statistically a significant association with mechanical birth trauma.

Frequent Skin Injuries in Neonates from Various Skin Injuries Monitoring Instruments: A Systematic Review

Aims: Maintenance of skin and tissue integrity is one of the main focuses of various health care facilities throughout the world so that the implementation of effective prevention of skin trauma requires a protocol for early identification of at-risk patients in prevention of skin trauma. Objective: Knowing the effektiveness of the SRAMT instrument compared to other skin trauma monitoring instruments for monitoring neonatal skin trauma. Method: This research method is in the form of systematic review, database search is done through proquest, SAGE Journal, Sciencedirect, Clinicalkey Nursing and manual research. There were eight journal articles that met the inclusion criteria. Based on the article it was concluded that the instrument had gone through validity, reliability, interrater tests and correlation coefficients so that it was suitable for use in pediatric and neonatal patients. Result: There were seven journal articles that met the inclusion criteria. The most common type of skin injury are caused by the use of an indwelling vascular catheter and medical devices. The most common locations for skin injury are the nasal septum and the head area, including the face and scalp. Compared to other skin injury monitoring instruments, the SRAMT subscale is more comprehensive by having three skin trauma risk assessment sections, including skin trauma risk categories, management guidelines based on skin injury risk categories and prevention that can be carried out based on the type of skin injury that occurred. This guide is very important to reduce the risk of skin injury in neonates and provide uniformity in nursing care provided by nurses.

Prevalence and Associated Factors of Hyperbilirubinemia Among Neonates Admitted to Neonatal Intensive Care Unit of Saint Peter Specialized Hospital, Addis Ababa, Ethiopia

<i>Introduction</i>: Neonatal hyperbilirubinemia is a widespread and significant clinical problem among neonates worldwide. Globally, every year about 1.1 million babies develop it and the vast majority resides in developing countries like Ethiopia. It is a major cause of hospital neonatal intensive care unit admission and readmissions during the neonatal period. As far as our knowledge is concerned there is no such study conducted in St. peter specialized hospital so far. Hence the objective of this study is to determine Prevalence and associated factors of hyperbilirubinemia among neonates admitted to neonatal intensive care unit of Saint Peter Specialized Hospital, Addis Ababa, Ethiopia from January, 1/2022 to January 1, 2023. <i>Methods</i>: A Facility based Retrospective cross sectional study was conducted among one hundred forty two (142) neonates admitted at St. peter specialized hospital by using systematic random sampling technique. Data on socio-demographic characteristics and, potential associated factors for hyperbilirubinemia were collected by a structured data extraction checklist. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Data entry was done by EPI info version 7, and analyzed using SPSS version 23.0. Binary logistic and multiple variable logistic regression models were used to identify associated factors. Association between were considered statistically significant only if A two-sided P-value <0.05 at 95% confidence level. <i>Result</i>: A total of 142 neonates were included in the study making response rate 100%. The overall prevalence of neonatal hyperbilirubinemia was 35 (24.6 %) with (95% CI: 17.6-31.7). Among several possible factors: Being male sex [AOR]:7.7, 95%CI (1.88, 32.1)], Birth trauma [AOR]: 17, 95%CI (3.8, 76.6), neonatal sepsis [AOR]: 10.9, 95%CI (2.9, 41.79)] and ABO incompatibility [AOR]: 22, 95%CI (4.7, 102.05)] were independent determinants of neonatal hyperbilirubinemia. <i>Conclusion and recommendation</i>: The prevalence of Neonatal Hyperbilirubinemia was quite high. Among identified associated factors for hyperbilirubinemia in this study: neonatal sex, Birth trauma, Sepsis and ABO incompatibility were the leading cause. Hence Health care provider working at NICU should undergo routine screening and investigations for TSB are imperative for early detection and timely intervention.

Alternative to Intensive Management of the Active Phase of the Second Stage of Labor: A Multicenter Randomized Trial (Phase Active du Second STade Trial) Among Nulliparous Women With an Epidural

ABSTRACT The optimal management of second stage of labor, with its passive and active phases, remains controversial. In France, delayed pushing during the active phase is recommended because of the belief that, based on older data, the fetus is at higher risk during the active phase. It is possible that uterine contractions combined with maternal pushing can lead to cord compression and reduce placental perfusion and oxygenation, which can induce acidosis and fetal heart rate abnormalities, resulting in the need for medical intervention, such as operative vaginal delivery (OVD) or episiotomy. In countries where the active phase is limited, women are encouraged to push as strongly as possible to speed delivery. However, if the active second stage of labor is prolonged, this intensive management may increase fetal hypoxia. The aim of this study was to examine the effect of moderate pushing versus intensive pushing in the second stage of labor on the risk of neonatal morbidity. This was a multicenter, randomized controlled trial at 13 French maternity units between January 2017 and May 2020. Included were nulliparous, adult women who had spontaneous or induced, uncomplicated delivery of a singleton fetus at ≥37 weeks of gestation. Excluded were women with a psychiatric condition, a disease contraindicating intensive expulsive efforts, or any uterine surgical scar, as well as those with a fetus that was small for gestational age, had congenital abnormalities, or had abnormal heart rate. Eligible women were randomized into 2 groups: the intervention group was instructed to push moderately only during the active phase of the second stage of labor, and the control group was instructed to push intensively during the same phase following French recommendations. Midwives asked the intervention group to push 2 times during each contraction and to take a break with no pushing in 1 of 5 contractions. No limit was set on pushing duration. The control group was asked to push 3 times per contraction without breaks. After 30 minutes of pushing, the midwife contacted an obstetrician to consider operative delivery. The primary outcome was a composite of neonatal acidosis, a 5-minute Apgar score &lt;7, and/or severe neonatal trauma. Secondary neonatal outcomes were transfer to the neonatology unit or intensive care unit need for resuscitation at birth and need for hypothermia. Secondary maternal outcomes were mode of delivery, postpartum hemorrhage (PPH), and severe PPH. The trial was stopped prematurely because of difficulties obtaining an adequate sample size. Of the 3380 women initially planned, 1710 (50.6%) were included. Ultimately, the intention-to-treat analysis included 809 women in each group. The neonatal morbidity rates for the intervention group and control group were 18.9% and 20.6%, respectively (risk ratio [RR] 0.92; 95% confident interval [CI], 0.75–1.12; P = 0.38). No significant differences were observed for neonatal transfer or need for resuscitation. All but 16 women delivered vaginally. The intervention or moderate pushing group had a longer pushing duration than the control or intensive pushing group (38.8 ± 26.4 vs 28.6 ± 17.0 minutes; P &lt; 0.001) and lower episiotomy rate (13.5% vs 17.8%; RR, 0.76; 95% CI, 0.60–0.95; P = 0.02). The rates of OVD were 21.1% in the intervention group and 24.8% in the control group (RR, 0.85; 95% CI, 0.71–1.02; P = 0.08). No significant differences were observed for PPH or severe PPH. During the active stage of labor, encouraging women to push moderately versus intensively was not associated with decreased neonatal morbidity. Although the pushing duration was longer among women instructed to push moderately, the rate of episiotomy was lower.

Maternal and neonatal complications following Kielland's rotational forceps delivery: A systematic review and meta-analysis.

There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non-rotational forceps delivery (NRFD) or a second-stage caesarean section (CS), from a systematic review and meta-analysis of the literature. Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Case series, prospective or retrospective cohort studies and population-based studies. A meta-analysis using a random-effects model was used to derive weighted pooled estimates of maternal and neonatal complications. Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non-rotational forceps (RR0.79, 95%CI 0.65-0.95) and second-stage CS (RR0.45, 95%CI 0.36-0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR1.79, 95%CI 1.08-2.98), but rates of neonatal birth trauma were lower (RR0.49, 95%CI 0.26-0.91). There were no differences seen in the rates of 5-min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second-stage CS (RR0.47, 95%CI 0.23-0.97). Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour.

Birth-related soft tissue injury due to transverse malpresentation at delivery: a case report

Abstract Objectives Birth-related mechanical trauma to the newborn is an important issue and may be underestimated [Chaturvedi A, Chaturvedi A, Stanescu AL, Blickman JG, Meyers SP. Mechanical birth-related trauma to the neonate: an imaging perspective. Insights Imag 2018;9:103–18]. Risk factors for birth-related injuries include vacuum or forceps delivery, large size for gestational age and abnormal presentation before delivery [Gupta R, Cabacungan ET. Neonatal birth trauma: analysis of yearly trends, risk factors, and outcomes. J Pediatr 2021;238:174–80]. When a newborn has a soft tissue mass, there is a wide range of potential diagnoses, ranging from benign traumatic origins to aggressive phenotypes of malignant tumors [Thacker M. Benign soft tissue tumors in children. Orthop Clin N Am 2014;44:433–44]. Diagnosing a congenital tumor in a newborn creates uncertainty for parents and health care providers. Accurate imaging is crucial for distinguishing soft tissue mass origins. Case presentation A 32 weeks 6 days pregnant Caucasian woman was admitted after premature prelabor rupture of membranes (PPROM). Fetal ultrasound showed no abnormalities, the infant was born by a caesarean section. The delivery was complicated by the infant’s transverse position. A female infant was born with a large left-sided dorsal soft tissue mass at the thoracic level with elastic consistency, and multiple skin lacerations. A broad differential diagnosis was made. Additional imaging was suggestive for a posttraumatic swelling due to transverse position during birth. The mass decreased and disappeared over three days. Conclusions The diagnosis of a soft tissue mass in a newborn can be challenging. A birth-related trauma affecting the soft tissue should be considered, especially if prenatal ultrasound findings were normal. Malpresentation during birth is a significant risk factor. Accurate diagnostic imaging is important to do before conducting further diagnostic examinations. The time course of the mass, before and after birth, can aid in determining its origin.

31 - A case of neonatal trauma after maternal gunshot wound

31 - A case of neonatal trauma after maternal gunshot wound

Prevalence and Patterns of Neonatal Birth Trauma in Ethiopia: Systematic Review and Meta-Analysis.

Introduction. Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common contributing factors for the death. Nevertheless, there is no aggregate evidence on the prevalence and patterns of neonatal birth trauma in Ethiopia. Therefore, this study aimed to assess the pooled prevalence and patterns of neonatal birth trauma in Ethiopia. Methods. Searching databases including PubMed, MEDLINE, Popline, SCOPUS, Web of Science, EMBASE, CINHAL (EBSCO), Google, Google Scholar, and lists of references were used to search literatures in Ethiopia. STATA version 14 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for I2 and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias. Results. A total of 6 studies with a sample size of 3663 were included in this study. The overall prevalence of neonatal birth trauma was 15% (95% CI: 13-16). Subgaleal hemorrhage (39%), cephalohematoma (27%), and caput succedaneum (24%) were the most common neonatal birth trauma in Ethiopia. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios, and the funnel plots did not show publication bias. Conclusion. This systematic review and meta-analysis revealed a high prevalence of neonatal birth trauma in Ethiopia. Moreover, most of the neonatal birth injuries were severe and life-threatening that need medical attention to safe the neonates and its life long complications.

Neonatal Birth Trauma and Its Predisposing Factors Among Newborns Admitted to Public Hospitals in Eastern Ethiopia: A Cross-Sectional Study.

Objectives: This study is to investigate the magnitude and predisposing factors for neonatal birth trauma in public hospitals in eastern Ethiopia. It is a major cause of neonatal morbidity and mortality. Despite its higher burden, evidence is limited in eastern Ethiopia. Methods: A cross-sectional study was conducted on 492 newborns selected using systematic random sampling. Data were analyzed using a binary logistic regression model. Statistical significance was set at P < .05. Results: The magnitude of neonatal birth trauma was 16.9% with 95% CI: 13.7-20.5%). In multivariable analysis, instrumental delivery, early preterm (<34 weeks), macrosomia, fetal malpresentation, male sex and, facility-based delivery such as hospital and health center-based delivery were factors associated with neonatal birth trauma. Conclusions: The magnitude of neonatal birth trauma was relatively high. Promoting health facilities-based delivery, prevention of preterm birth, the early decision on the mode, and minimizing instrumental deliveries help reduce neonatal birth trauma.