The process of the birth of newborns is always associated with a certain risk. Any mistakes made by a doctor or the peculiarities of the female body cause consequences that significantly worsen the quality of a person's adult life. Birth injury head leads to a lot of brain damage.

Causes of damage

Traumatization occurs during mechanical action in the process of birth, as a result of which the structure of tissues is disturbed. In other words, they speak of such a phenomenon when newborns have injuries that arose during its birth. It is not always the doctor's mistakes that affect the likelihood of a birth injury. Often, damage is formed due to the wrong lifestyle of a pregnant woman, the structural features of the woman's pelvis, the position of the fetus, and for a number of other reasons.

Features of the structure of the head of a newborn

The structure of the head in newborns has several significant differences. Before birth, this part of the body is the largest. In most cases, the fetus moves with its head forward. As a result, she experiences maximum stress. She manages to maintain her former form due to two qualities:

• elasticity;
• elasticity.

Fontanelles influence the development of the first quality. These structures are cavities between the bones of the skull, filled with a dense membrane. The latter is formed from the hard shell of the brain and periosteum. Newborns have four fontanelles.

The increased elasticity of the child's skull is also due to the structural features of the sutures made of connective tissue. This structure provides a relatively free passage of the head through the birth canal. When a child's skull is under load, it is slightly deformed, while eliminating the possibility of injury to the tissues and the brain.

Birth trauma in newborns appears with strong compression. Such an impact leads to damage to the structural elements and tissues of the skull. After birth, the head remains deformed.

Risk factors

Such damage occurs under the influence of three specific factors. Let's consider them in more detail:

The extensor insertion of the head also leads to brain damage in newborns. More often the skull is injured under the influence of a group of factors. The development of congenital pathologies is facilitated by a caesarean section performed before the onset of contractions. When the fetus is forcibly removed, negative pressure is formed inside the uterus. To get the child, the doctor has to make an effort. And with an unsuccessful position of the hands, there is a high probability of injury.

Clinical picture

There is a general classification of birth injuries. The latter are divided into:

In addition, birth injuries are usually classified into the following types:

1. Spontaneous. It occurs for reasons not due to the actions of the doctor.
2. Obstetric. The injury was caused by the erroneous actions of the doctor who delivered the baby.

The clinical picture depends on the localization of pathological disorders and their severity. Postpartum symptoms appear either immediately or after a certain time (sometimes after several years).

The short-term consequences of head injury in a child are of the following types:

Congenital brain injuries include hemorrhages of various types. Injury to the head during labor often leads to the formation of intracranial hemorrhages. Because of this, brain functions are disturbed, as indicated by:

As the condition worsens and the size of the intracranial hematoma increases, the mood of the child changes: he constantly screams, is in an excited state. In extreme cases, death is possible.

Newborn recovery

It is possible to detect skull injuries in a newborn only after a comprehensive examination using ultrasound, MRI and other devices. Restoration of a child after such injuries is carried out mainly in a hospital, where children are provided with the most sparing treatment.

In the presence of small abrasions, the affected area is treated with a solution of brilliant green, and the child is prescribed antibiotics to prevent infection of the body (Amoxicillin). The same drugs are used for various edema.

Most often, cephalohematoma gradually resolves without medical intervention. The process takes about two months. In rare cases, ossification of the formation occurs, which leads to deformation of the child's skull. To prevent this, in severe cases, cephalohematomas are removed during the first 10 days of life. The procedure is carried out using two special needles. Subgaleal hematomas are also removed through a small incision made on the scalp.

Surgical intervention is indicated if multiple fractures were detected during the examination of the head. During the operation, the doctor restores the shape of the skull by means of an elevator that is inserted inside the skull. Blood clots are removed with a craniotomy. The procedure is indicated in the presence of multiple lesions. Craniotomy involves the gradual removal of blood through punctures.

In order to avoid negative consequences in case of birth injuries of the head, the child is prescribed:

1. Compensatory therapy with the use of mechanical ventilation in the mode of moderate hyperventilation.
2. Anti-edematous therapy. Dexamethasone, Furosemide, Eufillin are used.
3. hemostatic therapy. Dicynon is introduced.
4. Anticonvulsant therapy. Sibazon, Phenobarbital are prescribed.
5. metabolic therapy. Piracetam, Curantyl are used.

Possible consequences

Complications of birth trauma of the skull are diverse. In the event of brain damage, parents of a newborn may eventually experience:

• lag in the intellectual development of the child;
• neuroses;
• epilepsy.

With hydrocephalus, there is a gradual accumulation of cerebrospinal fluid in the ventricles of the brain. With such a pathology, the child's head circumference is actively increasing. Symptoms of hydrocephalus include:

In the future, there are frequent headaches and epileptic seizures. Hydrocephalus leads to a lag in intellectual development, which becomes noticeable after a few years. This problem can be identified by the following features:

• aggressive or indecisive behavior;
• difficulties with adaptation in society;
• isolation;
• unstable attention;
• problems with remembering information;
• the child is late to start holding his head.

Birth injuries of the skull can lead to the development of oligophrenia, characterized by an inability to acquire new skills and a lack of critical thinking. The defeat of the central nervous system is complicated by such pathologies:

Epilepsy is considered a serious consequence of birth trauma. It occurs against the background of oxygen starvation, causing disruption of the brain cells. Seizures are a hallmark of epilepsy.

Cerebral palsy develops as a result of brain damage and is characterized by impaired motor and speech functions, developmental delay. It is possible to identify such a complication by the following symptoms:

• long preservation of primary reflexes;
• wrong gait;
• speech problems;
• hearing and vision impairment;
• convulsions;
• mental retardation.

Often, such violations cause the appearance of:

• paralysis;
• muscle atrophy;
• headaches;
• spasms of the limbs;
• dysfunction of the speech apparatus;
• delays in physical development.

Birth injuries are quite common. Due to head injuries, multiple complications occur, manifested in the form of a violation of intellectual and physical development, disorders of the central nervous system, and others. Birth trauma can lead to death. To avoid the development of severe complications, the elimination of the consequences is carried out during the first days of the child's life. Therefore, parents at this time need to be extremely careful in order to notice the symptoms of pathological changes in time.

Care

Diapers

swaddling

The birth process is quite unpredictable and can result in complications for both the mother and the baby. One such complication is birth trauma.

What's this?

Birth injuries of newborns are pathological conditions that occur during childbirth, in which tissues or organs are damaged in a newborn, as a result of which their functions are impaired.

With prenatal trauma in a newborn, the work of the main body systems is disrupted.

Types of injury

All injuries during childbirth are divided into:

1. Mechanical. These are bone fractures, head injuries, birth tumors, various hemorrhages, spinal cord and central nervous system injuries, cephalohematomas, injuries of the cervical spine, nerve damage, traumatic brain injury and other pathologies.
2. hypoxic. They are represented by damage to the internal organs and tissues of the brain, which leads to hypoxia and asphyxia during the birth process.

Cardiotocography is one of the methods for early diagnosis of intrauterine fetal hypoxia

Depending on the location of the lesion, injuries are distinguished:

• Bones.
• Soft tissues.
• nervous system.
• Internal organs.

Common Causes

To the appearance of mechanical birth injuries cite various obstacles in the advancement of the fetus through the female birth canal.

Cause of hypoxic injury is the complete or partial cessation of oxygen access to the child.

CNS damage or traumatic brain injury of the baby is one of the most common problems during childbirth.

Predisposing factors for which the risk of child injury during childbirth increases, include:

• Large fruit weight.
• Prematurity of the child.
• Narrow pelvis of a pregnant woman.
• Maternal pelvic injury.
• Wrong presentation.
• Mom's old age.
• The rapidity of the birth process.
• Prolongation of the birth process.
• Stimulation of childbirth.
• C-section.
• Use of midwifery aids and devices.
• Postmaturity.
• Chronic fetal hypoxia.
• Problems with the umbilical cord (entanglement, short length).

For a detailed explanation of how prenatal injuries occur in a baby, see the video:

Symptoms

• The most common birth injuries are swelling of the soft tissues of the child's head, which is called a birth tumor. It looks like a small swelling on the head of a newborn. With such edema, babies can also experience hemorrhages in the skin in the form of small dots.
• Cephalhematoma is manifested by hemorrhage in the baby's head. It occurs due to displacement of the skin and rupture of blood vessels, as a result of which blood collects under the periosteum of the cranial bones. The tumor appears immediately after childbirth and in the first two or three days its size increases.
• Bleeding into the muscles often appears in the neck(in the sternocleidomastoid muscles) and looks like a moderately dense formation of a small size (for example, the size of a nut or the size of a plum).
• Among bone fractures, the clavicle (often right) is most often damaged without displacement. With such an injury, when feeling the body of a newborn at the site of a broken collarbone, swelling, crunching and soreness are detected. Fractures of the femur or humerus are much less common. With them, movements in the limbs are impossible, their lethargy and soreness are noted.

Hematoma on the head of a newborn

• Nerves can be damaged due to both hypoxia and mechanical trauma. The most common nerve problem is damage to the facial nerve. Often there are also injuries of the brachial plexus.
• Traumatic brain injury may vary in severity. In severe cases, the baby may die in the first days or even hours after birth. Also, in severe trauma, organic changes in the tissues of the nervous system are possible, manifested by paralysis, paresis, and the development of mental retardation. Immediately after childbirth, the baby may develop convulsions, inhibition of the sucking reflex, breathing problems, severe crying, tremors of the arms and legs, insomnia, and other symptoms of CNS excitation. Further, the baby becomes lethargic, his cry and muscle tone weakens, the skin turns pale, the child sleeps a lot, sucks badly, burps a lot.
• Injuries of internal organs are less common than other types of injuries and usually do not appear in the first time after childbirth. The baby may have damage to the adrenal glands, spleen, or liver. The condition of the baby worsens from the third to fifth day of life, when the hematoma in the damaged organ ruptures, which leads to internal bleeding and anemia.

Consequences

The prognosis for birth injuries is affected by the severity of the injury, the timeliness of treatment, and the correctness of the selected therapy. If the child was correctly diagnosed in time and treated immediately, in 70-80% of cases he fully recovers.

The least dangerous damage to soft tissues and bones. The birth tumor usually disappears in one or two days without any consequences for the child's body. A small cephalohematoma resolves by 3-7 weeks of life without treatment. Due to a hemorrhage in the muscles of the neck, the child develops torticollis, in which the head of the crumbs leans towards the formation, and the chin is directed in the opposite direction. This condition is corrected by a special massage.

The magnitude of the hematoma affects the consequences of damage to internal organs. No less important is the extent to which the function of the affected organ has been preserved. For example, a large hemorrhage in the adrenal glands in many children leads to the development of chronic insufficiency of these glands.

The consequences of hypoxic injuries depend on the duration of the period when the child experienced a lack of oxygen. If such a period was long, a severe degree of delay in intellectual and physical development is possible, caused by the death of nerve cells in the brain. Children may develop cerebral palsy, hydrocephalus, seizures, nerve damage, encephalopathy and other pathologies. With an average degree of hypoxia in older children, increased fatigue, headaches, dizziness, and posture problems may occur.

For information on what hypoxia is and how to avoid it, see the following story:

Therapy

In most cases birth injuries are diagnosed in the maternity hospital, where the child is immediately prescribed the right treatment. In case of fractures, the damaged area is immobilized. In a serious condition of the baby, he is fed through a tube with colostrum, which the mother expresses.

With a severe degree of hypoxia, the treatment of the baby is carried out in the conditions of resuscitation of newborns.

In the treatment of injuries, depending on the type of damage, agents for blood vessels and the heart, drugs that affect the central nervous system, hemostatic agents, oxygen therapy, the introduction of vitamins and glucose are used.

Content:

When born, children can get birth injuries - serious damage to organs and tissues. They also include a holistic response of the body to these disorders. No one is safe from them, but if there is such a threat, doctors do everything possible to prevent any, even the slightest injury to the baby. However, the delivery process until the very end is unpredictable and can go completely differently than planned. That is why, even with modern medical equipment and highly qualified doctors, the percentage of birth injuries is quite high. This is explained by a variety of factors.

Too much when a baby is born is completely unpredictable. The organisms of mother and child can behave differently, and medical omissions are not excluded. The reasons can be both external and internal factors. According to statistics, birth injuries in newborns are due to the following indicators.

"Maternal" factors:

• early or late age of a woman;
• hyperanteflexia, uterine hypoplasia,
• preeclampsia;
• narrow pelvis;
• cardiovascular, gynecological, endocrine diseases;
• occupational hazards (if a woman, for example, worked in the chemical industry);
• delayed pregnancy.

Fetal pathologies:

• large sizes;
• prematurity;
• abnormal (with a turn) position of the fetus;
• asphyxia;
• asynclitic (incorrect) or extensor insertion of the head.

Anomalies of labor activity:

• protracted childbirth;
• discoordinated or strong, as well as weak labor activity.

Mistakes in obstetrics:

• turning the fetus on the leg;
• the use of forceps (this is the main cause of birth trauma of the central nervous system in children, since not only the baby’s limb is often damaged, but also the spine with the spinal cord);
• vacuum extraction of the fetus;
• C-section.

Very often, birth injuries in newborns are caused by a combination of several adverse factors that disrupt the normal course of childbirth. As a result of an undesirable combination of circumstances, some of the internal organs or vital functions of the fetus are violated, and to varying degrees. Some of them are so serious that they are diagnosed immediately. However, in some cases they can manifest themselves only over time.

According to statistics. In Russia, according to statistics, 18% of births end in injuries to the baby. But, given the problems of diagnosis in maternity hospitals, statisticians assure that the official figure is significantly underestimated.

signs

In hospitals, injuries during childbirth in a child are diagnosed only in cases where their signs are literally visible to the naked eye and represent open mechanical damage:

• fractures;
• breaks;
• tears;
• dislocations;
• hemorrhages (hematomas);
• compression.

Since birth injuries in children require, in some cases, a judicial and prosecutorial investigation due to the identification of medical errors, neonatologists and pediatricians do not diagnose them too actively. Therefore, most often the symptoms are detected after discharge from the hospital and are explained by pathologies of intrauterine development or improper care of the newborn in the first days of his life.

Symptoms of soft tissue injuries:

• scratches, petechiae (pinpoint hemorrhages), abrasions, ecchymosis (bruises);
• tumors;
• absence, its painlessness, often accompanied by jaundice and anemia.

Signs of trauma to the skeletal system:

• swelling and swelling;
• inability to perform active movements with the injured limb;
• pain syndrome, because of which the child often cries a lot;
• the main signs of intracranial birth trauma are muscle weakness, temperature changes, asthma attacks, uncoordinated movements of the limbs, their trembling, convulsions, spontaneous eye movement, bulging of the fontanel, drowsiness, crying weakness;
• deformities, shortening of the limbs.

Symptoms of internal injuries:

• bloating;
• , atony;
• depressed physiological reflexes;
• constant profuse regurgitation;
• arterial hypotension;
• vomit.

Signs of CNS disorders:

• lethargy, areflexia;
• muscle hypotension;
• weak cry;
• diaphragmatic breathing;
• autonomic disorders: sweating, vasomotor reactions;
• shortness of breath, cyanosis, bulging of the chest;
• congestive pneumonia;
• asymmetry of the face, mouth;
• displacement of the eyeball;
• difficulty in sucking.

Most of the symptoms of birth trauma in a baby do not appear immediately, but only 4-5 days after its birth. It often happens that the mother attributes lethargy and drowsiness to the normal state of the crumbs, and in the meantime, there is damage to any internal organ. It is possible to make the correct diagnosis only after a comprehensive examination and the delivery of appropriate tests. They will depend on the type of birth injury.

With the world on a string. The charming wry smile of Hollywood actor Sylvester Stallone is nothing more than a consequence of a serious birth injury. As well as a severe speech impediment, from which the artist had to get rid of for a long time.

Kinds

Depending on the causes and nature of the injuries, there are various types of birth injuries, the main classifications of which are two.

Classification No. 1 (for reasons)

1. If intrauterine pathologies and fetal anomalies were the provoking factors, neonatal birth trauma in a child is diagnosed. In some cases, it can be prevented if detected in advance by ultrasound.
2. Spontaneous trauma occurs during normal labor.
3. Obstetric trauma is caused by certain physical actions, doctor's manipulations.

Classification No. 2 (by damage)

1. Damage to soft tissues: skin, muscles, subcutaneous tissue, tumor, cephalohematoma.

2. Injury to the osteoarticular system: fractures, cracks in the clavicle, femur, humerus, epiphysiolysis of the shoulder, subluxation of the joints, damage to the bones of the skull.

3. Violations in the work of internal organs: hemorrhages in the liver, adrenal glands, spleen.

4. Birth injuries of the central nervous system:

• more often than others, intracranial birth trauma is diagnosed, since the soft bones of the skull do not withstand compression and pressure by the birth canal;
• spinal cord
• peripheral nervous system (Duchene-Erb paralysis, Dejerine-Klumpke, paresis of the diaphragm, facial nerve).

Each of the injuries is dangerous for the life of the baby and does not pass without consequences. Particularly often diagnosed is a birth injury to the head, which paves the way for the entire body and is thus squeezed or broken. The result is a violation of the functioning of the central nervous system, which is practically untreatable. Much less often, such cases occur during caesarean section, but it does not guarantee 100% safe removal of the baby into the world from the mother's womb.

Data. In 90% of women who have children with cerebral palsy, delivery was artificially induced or accelerated.

Caesarean section - salvation?

According to statistics, birth injuries during caesarean section are rare, but not excluded. It seems that with a planned, well-thought-out operation, any surprises can be avoided, but nature also makes its own adjustments here. Doctors explain this by various factors:

1. Strong compression of the child during the passage of the birth canal starts the work of his cardiovascular and respiratory systems. With cesarean delivery, this mechanism is absent, the restructuring of the body to function outside the uterus occurs in other, unnatural ways, which further affects the development of the child's central nervous system.
2. They themselves can lead to birth injuries.
3. The technique of the operation does not exclude mechanical damage to the fetus.

So in children, even after caesarean doctors diagnose skull injuries, displacement of several cervical vertebrae at once, retinal hemorrhages and other injuries. Those young mothers who consciously insist on an operation in the absence of medical indications for it should understand that it is not always possible to protect the baby from injury in this way.

Keep in mind! With a cesarean section, the doctor makes a transverse incision on the uterus 25 cm long. And the average circumference of the shoulders in most babies is at least 35 cm. Accordingly, obstetricians have to make an effort to remove them. Therefore, birth trauma of the cervical spine is so common in children born through this operation.

Care

Young mothers should keep in mind the specifics of caring for children who have suffered birth trauma in order to minimize its negative consequences. Treatment is very diverse, as it depends on the type of damage, their severity, aggravating factors. If the injury is very serious, and the woman does not have a medical education, nurses are often invited, who are able to professionally care for such children.

If the skeletal system (limbs) is damaged

1. Special care is not required.
2. Constant supervision at the local pediatrician.
3. Surgical control in the first 2 months of a baby's life.
4. Avoid re-injury to the bone.
5. 2 weeks after birth, an x-ray is taken and a conclusion is made about the fusion of the bones.

Spinal injury

1. Regular exercise therapy.
2. Constant dispensary supervision.
3. Therapeutic and preventive massage.
4. Spinal cord injury is very dangerous, but with proper care, babies live a long time: measures must be taken to prevent bedsores, ongoing treatment of the urinary system and various infections, and periodically take the child to examinations to detect uropathy.

With soft tissue injury

1. Care is not difficult.
2. An exception breastfeeding within 3-5 days. Drink expressed milk.
3. Abrasions are treated with a solution of brilliant green.
4. Complete peace.
5. Controlling external symptoms of birth trauma.

Damage to internal organs

1. Syndromic treatment.
2. Constant monitoring of the pediatrician.

Intracranial trauma

1. Gentle mode.
2. In a serious condition - finding a child in a couveuse (a specially equipped incubator).
3. In the presence of convulsions, respiratory disorders, asphyxia, any movements of the child are excluded. It will be necessary to provide him with maximum immobility.
4. Leather processing, feeding, swaddling are done in the crib.
5. Any trauma to the head during childbirth (both internal and external) involves feeding with a spoon or pipette, possibly tube feeding.

Massage

Of great importance are exercise therapy and therapeutic massage in case of damage to the spine and limbs, cerebral palsy. They strengthen weakened muscles, improve blood circulation and metabolic processes in the affected area, restore coordination of movements, fight limited mobility or curvature of the spine, and have a general strengthening effect on the body. Parents of affected babies should know the features of baby massage for birth injuries and learn it in order to help the baby at home.

1. For the procedure, heated oils are used (preferably olive or fir).
2. To relax damaged or atrophied muscles, stroking, felting, shaking, light vibration are used.
3. To stimulate them - planing, deep stroking, kneading, rubbing with weights, hatching.
4. Tapping, squeezing techniques are strictly prohibited.
5. Massage is performed on the back, collar area, arms (starting from the shoulder), legs (starting from the hip), chest, abdomen.
6. The duration of the procedure is from 5 to 15 minutes.
7. The course includes 20-35 sessions.
8. 4 to 6 courses are required per year.
9. In addition to the classic, segmental or acupressure massage can be prescribed.

If the damage is serious and has caused irreversible consequences, the child needs professional care, in particular, a birth injury of the brain requires neurosurgical care in a hospital. The period in the first 1-5 months of a baby's life is especially difficult. If he was given timely, competent help from doctors, proper care from his parents, the body will recover as much as possible and return to normal as much as possible. However, much depends on the severity of the deviation. For example, a birth injury of the neck in a newborn without damage to the central nervous system can be completely neutralized. But if the nerve endings are damaged, the consequences cannot be avoided even with proper care.

On a note. The use of any stimulants during childbirth (prostaglandins, kelp, antiprogestogens, balloons, oxytocin), as well as a bladder puncture, often leads to damage to the baby's central nervous system. Moreover, in 90% of cases, it is not detected at the time of childbirth, but is diagnosed by a neurologist later.

Consequences

Complications and consequences of birth injuries are of varying degrees. With timely diagnosis, professional treatment and proper care, they can be avoided. But some processes turn out to be irreversible and significantly affect the functioning of the brain, while threatening not only the health, but also the life of the baby. The most common and severe consequences are called:

• - dropsy of the brain;
• jumps in intracranial pressure;
• retardation in mental and physical development, cerebral palsy (these are the most frequent and dangerous consequences of a birth traumatic brain injury when the child's central nervous system is damaged);
• reduction or complete absence of some reflexes;
• to whom;
• fatal outcome;
• spasms of the limbs;
• tachycardia;
• muscle atrophy;
• enuresis;
• hyperactivity, rapid excitability, increased nervousness;
• paralysis;
• diseases: bronchial asthma, food allergies, eczema, neurodermatitis, deformity of the spinal column (this is most often caused by a birth injury of the spine), paresis, disorders in the functioning of the cardiovascular system.

Parents of children who have received birth injuries should be extremely attentive to such babies and be as patient as possible. If CNS lesions are superficial and not accompanied by total changes in the functioning of the brain and spinal cord, recovery is possible with complex treatment and caring care. Despite this, many of these kids in the long term - 95% delay in mental, motor, speech development, impaired muscle tone. The consequences of birth trauma are often very, very distant.

For your information. Early clamping of the umbilical cord is one of the causes of encephalopathy and mental retardation in children.

Prevention

To avoid such negative and very life-threatening consequences for the baby, birth injuries are prevented even in the neonatal period by both parents and doctors:

• planning conception and pregnancy in advance;
• timely treatment of diseases in both parents;
• healthy lifestyle of the mother during pregnancy;
• complete, balanced nutrition of a woman;
• immediate elimination of infections caught during pregnancy;
• obtaining professional medical care;
• regular consultations with a gynecologist.

Doctors should take into account during childbirth any pathologies and abnormalities in the development of the fetus, identified during pregnancy. This greatly reduces the risk of injury to the baby. Professionalism and competent, well-coordinated actions of obstetricians in case of any deviation that has arisen are a guarantee of a safe, successful delivery.

The birth process does not always proceed favorably for both the woman in labor and the child. Birth trauma in newborns occurs due to various reasons. Timely and adequate diagnosis and then treatment of this pathology is extremely important. Otherwise, the consequences can become unpredictable: from intellectual problems to disability or even death of the fetus.

What is a birth trauma of a child, we will consider in more detail below. In obstetric practice, this concept means such a condition of the child, which is characterized by damage to the integrity of tissues, organs or the skeleton and causes a violation of their functions.

All damage to the fetus in the birth process is conditionally divided into:

• mechanical, that is, created by some external stimulation;
• hypoxic, that is, occurring as a result of asphyxia or fetal hypoxia.

Functional disorders can be observed in various areas of the body and, depending on the location, are classified as follows:

• injuries of bones, joints (cracks or fractures of the shoulder, clavicle, femur and skull);
• damage to soft tissues (skin or muscles, cephalohematoma, birth tumor);
• injuries of internal organs (hemorrhages in the abdominal organs);
• disorders of the nervous system (damage to the nerve trunk in the brain or spinal cord).

The last type of trauma in newborns is divided into the following types:

• defects of the peripheral nervous system;
• injury in the spinal cord.

There is also a classification of birth injuries based on the actions of the obstetric team:

1. Spontaneous. It is formed in the process of standard or difficult childbirth for independent of medical staff reasons.
2. Obstetric. Occurs as a result of certain methods of the midwife (both correct and incorrect).

Cervical injury

The human cervical region is characterized by mobility, fragility and extreme sensitivity to all sorts of influences. In this regard, the cause of injury may be too rough bending, careless stretching or violent rotation.

In the birth process, various types of disorders in the neck can occur:

1. Distraction.
2. Rotational.
3. Compression-flexion.

A rotational violation of the neck occurs as a result of the actions of the obstetrician aimed at helping the child to move through the birth canal. In the process of manipulations performed by hands or obstetric forceps, rotational movements of the head are carried out, which in some cases lead to subluxation of the first cervical vertebra (atlas) or to a defect in the articulation of the first and second vertebrae.

Occasionally, the atlas shifts and the spinal canal narrows, which is accompanied by pressure on the spinal cord.

In some situations, at the time of natural childbirth and in the presence of a large fetus, obstetricians are required to make additional efforts that can cause separation of the vertebral bodies from the discs, rupture of ligaments in the neck, or dysfunction of the spinal cord.

Compression-flexion injuries are most common in rapid labor, especially when the fetus is large enough. When the child moves through the birth canal, his head experiences resistance, which is why compression fractures of the vertebrae are not excluded.

Consequences of natal injuries of the cervical spine

Birth trauma to the neck causes:

1. Osteochondrosis and scoliosis.
2. Decreased muscle tone with overall increased flexibility.
3. Weakness in the muscles of the shoulder girdle.
4. Clubfoot.
5. Headaches.
6. Violations in fine motor skills.
7. Vegetovascular dystonia.
8. Increased blood pressure.

Note! Three times more often birth injuries are recorded during the procedure of caesarean section than during the most natural childbirth. This is due to the so-called can effect.

When the child is pulled out artificially from the uterus, negative pressure is formed in it. The resulting vacuum prevents the free exit of the newborn.

It takes a lot of effort to get it out. Such manipulations can cause damage to the spine.

Intracranial injuries

Intracranial birth trauma of newborns is cerebral disturbances in brain activity of different location and degree of manifestation, which are formed during childbirth as a result of mechanical damage to the skull. Factors that can provoke injuries of this nature are conventionally divided into 2 groups:

1. Associated with the intrauterine state of the child.
2. Depending on the characteristics of the birth canal in the mother.

Factors associated with the prenatal state of the child:

• embryofetopathy: developmental defects with hemorrhagic syndrome, venous congestion in tissues;
• hypoxic state of the fetus due to placental insufficiency;
• prematurity: tissue weakness, a small number of elastic fibers, excessive vascular permeability, liver immaturity, insufficient prothrombin, soft cranial bones;
• post-term pregnancy: hypoxia that occurred against the background of involution of the placenta.

Factors that depend on the characteristics of the birth canal of the mother:

• rigidity of tissues in the birth canal;
• irregular shape of the pelvis;
• insufficient volume of amniotic fluid;
• premature discharge of amniotic fluid.

In violation of the blood circulation of the brain, an important role is played by the difference between the pressure of the atmosphere, which affects the presenting part of the head, and the intrauterine pressure, which increases with uterine contraction. In addition, in the pathogenesis of cerebral abnormalities, dislocation syndrome is of particular importance.

The fundamental factor of genesis is mechanical damage to the contents of the skull. Even with naturally proceeding childbirth, there is some difficulty in blood circulation. And in case of pathological delivery, unfavorable factors are summed up and even a slight mechanical stimulation of the head can provoke intracranial hemorrhage in premature babies as a result of damage to blood vessels or duplications of the brain membrane.

Depending on the location of the hemorrhage are divided into:

• epidural (between the membranes of the brain and the bones of the skull);
• subdural (between the meninges and the substance of the brain);
• intraventricular (blood in the ventricles of the brain).

The consequences of birth trauma are characterized by a number of features: from small deviations in development to serious pathologies. Often, due to hemorrhage in the internal organs, anemia develops. As a result of increased heat transfer and reduced heat production, the thermoregulation system is disrupted, and newborns suffer from rapid hypothermia.

Often, natal trauma causes hypoglycemia. Physiological weight loss is compensated more slowly, signs of jaundice persist for a long time. In connection with a decrease in specific and nonspecific immunity in newborns with intracranial injuries, infectious diseases (in particular pneumonia) are common.

Recovery of a child depends on the form and degree of brain damage and on the rationality and intensity of therapy in both acute and recovery periods.

Fatal cases occur in 3-10%, while cranial trauma accounts for 97% of all cases of birth trauma with a fatal outcome.

An absolute recovery is possible. But as a rule, 20-40% of children with hypoxic CNS lesions are diagnosed with residual signs:

• delay in physical, psycho-emotional and speech development;
• cerebrasthenic syndrome with neurosis-like symptoms;
• scattered microsymptoms in the foci;
• moderate hypertension (intracranial);
• hydrocephalus (compensated or progressive);
• epilepsy.

In 7% of children with posthypoxic encephalopathy, a severe organic lesion of the central nervous system is manifested with pronounced motor disorders (cerebral palsy) and mental disorders up to oligophrenia.

Birth trauma in newborns is a common occurrence, and it is impossible to completely protect yourself from traumatism in childbirth. But you can minimize the risks as much as possible. It is necessary for obstetricians to timely identify pregnant women at risk for perinatal pathology, as well as professional and competent use of various manipulations in childbirth. It is advisable for future mothers to plan conception after the treatment of chronic diseases and to register for pregnancy in a timely manner.

Birth trauma in newborns- this is a pathological condition that developed during childbirth and is characterized by damage to the tissues and organs of the child, accompanied, as a rule, by a disorder in their functions. Factors predisposing to the development of birth trauma in newborns are the incorrect position of the fetus, the discrepancy between the size of the fetus and the main parameters of the bone small pelvis of the pregnant woman (large fetus or narrowed pelvis), features of intrauterine development of the fetus (chronic intrauterine hypoxia), prematurity, postmaturity, duration of the act of childbirth (as rapid, or fast, and protracted labor).

The immediate cause of birth traumatism is often improperly performed obstetric aids when turning and extracting the fetus, applying forceps, a vacuum extractor, etc.

There are birth trauma of soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous system.

Birth injury of soft tissues:

Damage to the skin and subcutaneous tissue during childbirth (abrasions, scratches, hemorrhages, etc.), as a rule, are not dangerous and require only local treatment to prevent infection (treatment with 0.5% alcohol solution of iodine, application of an aseptic dressing); they usually disappear in 5-7 days.

More severe injuries include muscle damage.
One of the typical types of birth trauma is damage to the sternocleidomastoid muscle, which is characterized by either hemorrhage or rupture; the latter usually occurs in the lower third of the muscle. Such damage often develops during childbirth in the breech presentation, but also occurs when forceps and other manual aids are applied. In the area of ​​damage and hematoma, a small, moderately dense or doughy consistency, a tumor that is slightly painful on palpation, is determined.

Sometimes it is diagnosed only by the end of the 1st week of a child's life, when torticollis develops. In this case, the child's head is tilted towards the damaged muscle, and the chin is turned in the opposite direction. The hematoma of the sternocleidomastoid muscle should be differentiated from congenital muscular torticollis.
Treatment consists in creating a corrective position that helps to eliminate pathological tilt and turn of the head (rollers are used), the use of dry heat, potassium iodide electrophoresis; in more late dates prescribe a massage. As a rule, the hematoma resolves and after 2-3 weeks. muscle function is fully restored. In the absence of the effect of conservative therapy, surgical correction is indicated, which should be carried out in the first half of the child's life.

One of the manifestations of birth trauma in newborns, cephalhematoma, is a hemorrhage under the periosteum of any bone of the cranial vault (more often one or both parietal, less often occipital). It must be differentiated from a birth tumor, which is a local swelling of the skin and subcutaneous tissue of a newborn, is usually located on the presenting part of the fetus and occurs as a result of prolonged mechanical compression of the corresponding area.

A generic tumor usually occurs during prolonged labor, as well as with obstetric benefits (imposition of forceps). Unlike cephalhematoma, the birth tumor extends beyond one bone, it has a soft elastic consistency, fluctuations and a ridge along the periphery are not observed; the birth tumor disappears after 1-2 days and does not require special treatment.

Children who have suffered a birth injury of soft tissues, as a rule, fully recover and do not require special dispensary observation in the clinic.

Birth trauma of the skeletal system:

Birth trauma of the skeletal system includes cracks and fractures, of which the most commonly observed damage to the clavicle, humerus and femur. The reasons for them are incorrectly conducted obstetric benefits. A clavicle fracture is usually subperiosteal and is characterized by a significant limitation of active movements, a painful reaction (crying) with passive movements of the arm on the side of the lesion, and the absence of the Moro reflex.

With light palpation, swelling, soreness and crepitus over the fracture site are noted. Fractures of the shoulder and femur diagnosed by the absence of active movements in the limb, pain reaction during passive movements, the presence of swelling, deformation and shortening of the damaged bone. With all types of bone fractures, the diagnosis is confirmed by X-ray examination.

Treatment of a clavicle fracture consists in short-term immobilization of the arm using a Dezo bandage with a roller in the axillary region or by tightly swaddling the outstretched arm to the body for a period of 7-10 days (with the child laid on the opposite side). Fractures of the humerus and femur are treated by immobilizing the limb (after repositioning if necessary) and traction (often with adhesive tape). The prognosis for fractures of the clavicle, humerus and femur is favorable.

Rare cases of birth trauma in newborns include traumatic epiphysiolysis of the humerus, which is manifested by swelling, pain and crepitus on palpation in the area of ​​the shoulder or elbow joints, and limitation of movements of the affected arm. With this injury, flexion contracture in the elbow and wrist joints often develops in the future due to paresis of the radial nerve. Diagnosis is confirmed by radiography of the humerus. The treatment consists in fixing and immobilizing the limb in a functionally determined position for 10-14 days, followed by the appointment of physiotherapeutic procedures, the use of massage.

Children who have suffered a birth injury of the bones, as a rule, fully recover and do not require special dispensary observation in the clinic.

Birth trauma of internal organs:

It is rare and, as a rule, is the result of mechanical effects on the fetus with improper delivery, the provision of various obstetric benefits. However, a violation of the activity of internal organs is also often noted in case of birth trauma of the central and peripheral nervous system. It is manifested by a disorder of their function with anatomical integrity. The most commonly damaged liver, spleen and adrenal glands as a result of hemorrhage in these organs. During the first two days, there is no obvious clinical picture of hemorrhage in the internal organs (“light” gap).

A sharp deterioration in the child's condition occurs on the 3-5th day due to bleeding due to hematoma rupture, an increase in hemorrhage and the depletion of hemodynamic compensation mechanisms in response to blood loss. Clinically, this is manifested by symptoms of acute posthemorrhagic anemia and dysfunction of the organ into which the hemorrhage occurred. When hematomas rupture, abdominal distention and the presence of free fluid in the abdominal cavity are often noted. A pronounced clinical picture has a hemorrhage in the adrenal glands, which often occurs with breech presentation. It is manifested by a sharp muscular hypotension (up to atony), inhibition of physiological reflexes, intestinal paresis, a drop in blood pressure, persistent regurgitation, and vomiting.

To confirm the diagnosis of a birth injury of the internal organs, a survey radiograph and an ultrasound examination of the abdominal cavity are performed, as well as a study of the functional state of the damaged organs.

Treatment consists of hemostatic and post-syndromic therapy. With hemorrhage in the adrenal glands and the development of acute adrenal insufficiency, replacement therapy with glucocorticoid hormones is necessary. At a rupture of a hematoma, intracavitary bleeding make an operative measure.

The prognosis of a birth injury of internal organs depends on the volume and severity of organ damage. If the child does not die during the acute period of birth trauma, its subsequent development is largely determined by the preservation of the functions of the affected organ. Many newborns who have had a hemorrhage in the adrenal glands develop chronic adrenal insufficiency in the future.

With a birth injury of the internal organs, the pediatrician monitors the child's condition 5-6 times during the first month of life, then 1 time in 2-3 weeks. up to 6 months, then 1 time per month until the end of the first year of life (see Newborn, Perinatal period). In case of hemorrhage in the adrenal glands, it is necessary to observe a pediatrician, an endocrinologist and determine the functional state of the adrenal glands.

Birth trauma of the central nervous system:

It is the most severe and dangerous to the life of the child. It combines pathological changes in the nervous system that are different in etiology, pathogenesis, localization and severity, resulting from the impact on the fetus during childbirth of mechanical factors.

These include intracranial hemorrhages, injuries of the spinal cord and peripheral nervous system due to various obstetric pathologies, as well as mechanical damage to the brain that develops as a result of compression of the skull by the mother's pelvic bones during the passage of the fetus through the birth canal. Birth trauma of the nervous system in most cases occurs against the background of chronic fetal hypoxia caused by an unfavorable course of pregnancy (toxicosis, the threat of miscarriage, infectious, endocrine and cardiovascular diseases, occupational hazards, etc.).

Intracranial hemorrhage:

There are 4 main types of intracranial hemorrhages in newborns: subdural, primary subarachnoid, intra- and periventricular, intracerebellar. Trauma and hypoxia play the main role in their pathogenesis. Different types of intracranial hemorrhages, as well as the main pathogenetic mechanisms of their development, can be combined in one child, but one of them always dominates in the clinical symptom complex and the clinical symptomatology depends, accordingly, not only on cerebrovascular accident, but also on its localization, as well as on the severity of mechanical damage to the brain.

Subdural hemorrhages:

Depending on the localization, there are: tentorial hemorrhages with damage to the direct and transverse sinuses of the vein of Galen or small infratentorial veins; occipital osteodiastasis - rupture of the occipital sinus; rupture of the falciform process of the dura with damage to the inferior sagittal sinus; rupture of the connecting superficial cerebral veins. Subdural hematomas can be unilateral or bilateral, possibly combined with parenchymal hemorrhages resulting from hypoxia.

Tentorial hemorrhages:

Tentorial rupture with massive hemorrhage, occipital osteodiastasis, damage to the inferior sagittal sinus is characterized by an acute course with the rapid development of such symptoms of compression of the upper parts of the brain stem as stupor, eye aversion to the side, anisocoria with a sluggish reaction to light, a symptom of "doll eyes", muscle rigidity back of the head, opisthotonus posture; unconditioned reflexes are depressed, the child does not suck, does not swallow, there are bouts of asphyxia, convulsions.

If the hematoma grows, symptoms of compression and the lower parts of the brain stem appear: coma, dilated pupils, pendulum eye movements, arrhythmic breathing. In the subacute course of the pathological process (hematoma and a smaller gap), neurological disorders (stupor, excitability, arrhythmic breathing, bulging of the large fontanel, oculomotor disorders, tremor, convulsions) occur at the end of the first day of life or after several days and persist for several minutes or hours. A lethal outcome, as a rule, occurs in the first days of a child's life from compression of the vital centers of the brain stem.

Convexital subdural hematomas caused by rupture of the superficial cerebral veins are characterized by minimal clinical symptoms (anxiety, regurgitation, vomiting, tension of the large fontanel, Graefe's symptom, periodic fever, signs of local cerebral disorders) or their absence and are detected only during instrumental examination of the child.

The diagnosis of subdural hematoma is established on the basis of clinical observation and instrumental examination. Rapidly increasing stem symptoms make it possible to suspect a hematoma of the posterior cranial fossa resulting from a rupture of the cerebellar tentorium or other disorders. If neurologic symptoms are present, convexital subdural hematoma may be suspected.

Lumbar puncture in these cases is not desirable, because. it can provoke the herniation of the cerebellar tonsils into the foramen magnum with subdural hematoma of the posterior cranial fossa or the temporal lobe into the notch of the cerebellar tentorium in the presence of a large unilateral convexital subdural hematoma. Computed tomography is the most adequate method for diagnosing subdural hematomas, they can also be detected using ultrasound. During the transillumination of the skull, the subdural hematoma in the acute period is contoured by a dark spot against the background of a bright glow.

With severe ruptures of the cerebellar tentorium, falciform process of the dura mater and occipital osteodiastasis, therapy is not effective and children die as a result of compression of the brain stem. In the subacute course of the pathological process and the slow progression of stem symptoms, surgery is performed to evacuate the hematoma. In these cases, the outcome depends on the speed and accuracy of diagnosis.

With convexital subdural hematomas, the tactics of managing patients may be different. With a unilateral hematoma with signs of displacement of the cerebral hemispheres, massive hematomas with a chronic course, a subdural puncture is necessary to evacuate the spilled blood and reduce intracranial pressure. Surgical intervention is necessary if the subdural puncture is ineffective.

If neurological symptoms do not increase, conservative treatment should be carried out; dehydration and resolving therapy, as a result of which, after 2-3 months, the formation of the so-called constricting subdural membranes occurs and the child's condition is compensated. Long-term complications of subdural hematoma include hydrocephalus, convulsions, focal neurological symptoms, and psychomotor retardation.

Subarachnoid hemorrhage:

Primary subarachnoid hemorrhages are the most common. Occur when vessels of various calibers are damaged inside the subarachnoid space, small venleptomeningeal plexuses or connecting veins of the subarachnoid space. They are called primary in contrast to secondary subarachnoid hemorrhages, in which blood enters the subarachnoid space as a result of intra- and periventricular hemorrhages, aneurysm rupture.

Subarachnoid hemorrhages are also possible with thrombocytopenia, hemorrhagic diathesis, congenital angiomatosis. With primary subarachnoid hemorrhages, blood accumulates between separate parts of the brain, mainly in the posterior cranial fossa, temporal regions. As a result of extensive hemorrhages, the entire surface of the brain is covered, as it were, with a red cap, the brain is edematous, the vessels are overflowing with blood. Subarachnoid hemorrhages can be combined with small parenchymal hemorrhages.

Symptoms of subarachnoid hemorrhage:

Symptoms of neurological disorders depend on the severity of the hemorrhage, combination with other disorders (hypoxia, hemorrhages of other localization). More common are mild hemorrhages with clinical manifestations such as regurgitation, hand tremors, anxiety, increased tendon reflexes. Sometimes neurological symptoms may appear only on the 2-3rd day of life after the baby is put to the breast.

With massive hemorrhages, children are born in asphyxia, they have anxiety, sleep disturbance, general hyperesthesia, neck muscle stiffness, regurgitation, vomiting, nystagmus, strabismus, Graefe's symptom, tremor, convulsions. Muscle tone is increased, tendon reflexes are high with an expanded zone, all unconditioned reflexes are pronounced. On the 3-4th day of life, Harlequin syndrome is sometimes noted, manifested by a change in the color of half of the body of the newborn from pink to light red; the other half is paler than normal. This syndrome is clearly manifested when the child is positioned on its side. A change in body color can be observed within 30 seconds to 20 minutes, during this period the child's well-being is not disturbed. Harlequin syndrome is considered as a pathognomonic sign of traumatic brain injury and asphyxia of the newborn.

The diagnosis is established on the basis of clinical manifestations, the presence of blood and an increase in protein content in the cerebrospinal fluid. During the transillumination of the skull in the acute period, there is no halo of luminescence, it appears after the resorption of blood as a result of the progression of hydrocephalus.

To clarify the localization of the pathological process, computed tomography and ultrasound are performed. Computed tomography of the brain reveals the accumulation of blood in various parts of the subarachnoid space, and also excludes the presence of other hemorrhages (subdural, intraventricular) or atypical sources of bleeding (tumors, vascular anomalies). The method of neurosonography is uninformative, except for massive hemorrhages reaching the Sylvian sulcus (thrombus in the Sylvian sulcus or its expansion).

Treatment of subarachnoid hemorrhage:

Treatment consists in the correction of respiratory, cardiovascular and metabolic disorders. Repeated lumbar punctures to remove blood should be performed according to strict indications and very carefully, slowly removing cerebrospinal fluid. With the development of reactive meningitis, antibiotic therapy is prescribed. With an increase in intracranial pressure, dehydration therapy is necessary. The progression of hydrocephalus and the lack of effect of conservative therapy is an indication for surgical intervention (bypass).

The prognosis depends on the severity of neurological disorders. In the presence of mild neurological disorders or asymptomatic course, the prognosis is favorable. If the development of hemorrhage is combined with severe hypoxic and / or traumatic injuries, children usually die, and the few survivors usually have such serious complications as hydrocephalus, convulsions, cerebral palsy (see Infantile palsy), speech delay and mental development.

Intraventricular and periventricular hemorrhages:

Intraventricular and periventricular hemorrhages are most common in premature babies born weighing less than 1500 g. The morphological basis of these hemorrhages is an immature choroid plexus located under the ependyma lining the ventricles (germinal matrix). Until the 35th week of pregnancy, this area is richly vascularized, the connective tissue framework of the vessels is underdeveloped, and the supporting stroma has a gelatinous structure. This makes the vessel very sensitive to mechanical stress, changes in intravascular and intracranial pressure.

Causes:

High-risk factors for the development of hemorrhages are prolonged labor, accompanied by deformation of the fetal head and compression of the venous sinuses, respiratory disorders, hyaline-membrane disease, various manipulations performed by the midwife (mucus suction, blood exchange transfusion, etc.). In about 80% of children with this pathology, periventricular hemorrhages break through the ependyma into the ventricular system of the brain and blood spreads from the lateral ventricles through the openings of Magendie and Luschka into the cisterns of the posterior cranial fossa.

The most characteristic is the localization of the forming thrombus in the region of the large occipital cistern (with limited spread to the surface of the cerebellum). In these cases, ablative arachnoiditis of the posterior cranial fossa may develop, causing obstruction by CSF circulation. Intraventricular hemorrhage can also capture the periventricular white matter of the brain, be combined with cerebral venous infarcts, the cause of which is compression of the venous outflow tract by the dilated ventricles of the brain.

Symptoms:

Hemorrhage usually develops in the first 12-72 hours of life, but may subsequently progress. Depending on the extent and speed of spread, 3 variants of its clinical course are conventionally distinguished - fulminant, intermittent, and asymptomatic (oligosymptomatic). With a lightning-fast course of hemorrhage, the clinical picture develops over several minutes or hours and is characterized by deep coma, arrhythmic breathing, tachycardia, and tonic convulsions. The child's eyes are open, the gaze is fixed, the reaction of the pupils to light is sluggish, nystagmus, muscle hypotension or hypertension, bulging of the large fontanel are observed; reveal metabolic acidosis, decrease in hematocrit, hypoxemia, hypo- and hyperglycemia.

The intermittent course is characterized by similar, but less pronounced clinical syndromes and "wavy course, when a sudden deterioration is followed by an improvement in the child's condition. These alternating periods are repeated several times within 2 days until stabilization or death occurs. With this variant of the course of the pathological process, pronounced metabolic disorders are also noted.

Asymptomatic or oligosymptomatic course is observed in about half of children with intraventricular hemorrhage. Neurological disorders are transient and mild, metabolic changes are minimal.

The diagnosis is established on the basis of the analysis of the clinical picture, the results of ultrasound and computed tomography. It is believed that there are only 4 pathognomonic clinical symptoms: a decrease in hematocrit without apparent reason, lack of hematocrit growth against the background of infusion therapy, bulging of the large fontanel, changes in the child's motor activity. Ultrasound examination of the brain through a large fontanel allows you to determine the severity of hemorrhage and its dynamics.

Intraventricular hemorrhage:

With intraventricular hemorrhage, echo-dense shadows are found in the lateral ventricles - intraventricular thrombi. Sometimes thrombi are detected in the I and IV ventricles. Ultrasound examination also makes it possible to trace the spread of hemorrhage to the substance of the brain, which can be observed until the 21st day of a child's life. The resolution of the thrombus lasts 2-3 weeks, and a thin echogenic rim (cysts) is formed at the site of the echo-dense formation.

Hemorrhage into the germinal matrix:

Hemorrhage into the germinal matrix also leads to destructive changes followed by the formation of cysts, which are most often formed in the periventricular white matter of the brain - periventricular cystic leukomalacia. After the acute period, the ultrasound picture of intraventricular hemorrhage is manifested by ventriculomegaly, reaching a maximum by 2-4 weeks. life. Ultrasound examinations of the brain are recommended to be performed on the 1st and 4th days of a child's life (about 90% of all hemorrhages are detected during these periods).

Computed tomography for diagnostic purposes is performed in cases where there is a suspicion of the simultaneous presence of a subdural hematoma or parenchymal hemorrhage. When blood enters the subarachnoid space, lumbar puncture provides valuable information about the presence of a hemorrhage: an admixture of blood is found in the cerebrospinal fluid, an increase in the content of protein and erythrocytes (the degree of increase in protein concentration, as a rule, correlates with the severity of the hemorrhage), pressure is increased.

In the acute period, measures are taken to normalize cerebral blood flow, intracranial and blood pressure, metabolic disorders. It is necessary to limit unnecessary manipulations with the child, monitor the mode of pulmonary ventilation, especially in premature babies, constantly monitor pH, pO2 and pCO2 and maintain their adequate level to avoid hypoxia and hypercapnia. With developed intraventricular hemorrhage, progressive hydrocephalus is treated; repeated lumbar punctures are prescribed to remove blood, reduce intracranial pressure and control the normalization of cerebrospinal fluid.

Also used enterally drugs that reduce the production of cerebrospinal fluid, such as diacarb (50-60 mg per 1 kg of body weight per day), glycerol (1-2 g per 1 kg of body weight per day). If ventriculomegaly does not increase, then diacarb is prescribed in courses of 2-4 weeks. at intervals of several days for another 3-4 months. and more. In cases of progression of hydrocephalus and ineffectiveness of conservative therapy, neurosurgical treatment (ventriculoperitoneal shunting) is indicated.

Intra- and periventricular hemorrhage:

Mortality among newborns with intra- and periventricular hemorrhages is 22-55%. Surviving children form a high-risk group for developing complications such as hydrocephalus, psychomotor retardation, and cerebral palsy. A favorable prognosis is expected with mild hemorrhages in 80% of patients, with hemorrhages moderate- in 50%, in severe cases - in 10-12% of children.

The highest, but not absolute criteria for an unfavorable prognosis for children with intra- and periventricular hemorrhages are the following features of the acute period: extensive hematomas involving the brain parenchyma: lightning-fast onset of clinical manifestations with bulging of the large fontanelle, convulsions, respiratory arrest; posthemorrhagic hydrocephalus that does not spontaneously stabilize; simultaneous hypoxic brain damage.

Hemorrhages in the cerebellum:

Cerebellar hemorrhages result from massive supratentorial intraventricular hemorrhages in term infants and germinal matrix hemorrhages in preterm infants. Pathogenetic mechanisms include a combination of birth trauma and asphyxia. They are clinically characterized by a rapidly progressive course, as with subdural hemorrhages in the posterior cranial fossa: respiratory disorders increase, hematocrit decreases, and death quickly occurs. Perhaps a less acute course of the pathology, manifested by atony, areflexia, drowsiness, apnea, pendulum eye movements, strabismus.

The diagnosis is based on the detection of stem disorders, signs of increased intracranial pressure, ultrasound data and computed tomography of the brain.

Treatment consists of emergency neurosurgical intervention for the purpose of early decompression. With progressive hydrocephalus, shunting is performed, which is indicated for about half of children with intracerebellar hemorrhages.

The prognosis of massive cerebellar hemorrhage is generally poor, especially in preterm infants. Survivors have disorders caused by destruction of the cerebellum: ataxia, motor awkwardness, intentional tremor, dysmetria, etc.; in cases of blockade of the CSF pathways, progressive hydrocephalus is detected.

Atypical intracranial hemorrhages in newborns may be due to vascular anomalies, tumors, coagulopathy, hemorrhagic infarction. The most common type of hemorrhagic diathesis is K-vitamin deficiency hemorrhagic syndrome, hemophilia A, isoimmune thrombocytopenic purpura of newborns.

Hemorrhagic disorders in newborns can also be caused by congenital thrombocytopathy due to the appointment of the mother before the birth of acetylsalicylic acid, sulfanilamide drugs, while hemorrhages are mainly subarachnoid, not severe. Neonatal intracranial hemorrhages can cause congenital arterial aneurysms, arteriovenous anomalies, coarctation of the aorta, brain tumors (teratoma, glioma, medulloblastoma).

Spinal cord injury in newborns:

Spinal cord injury is the result of mechanical factors (excessive traction or rotation) during the pathological course of childbirth, leading to hemorrhage, stretching, compression and rupture of the spinal cord at various levels. The spine and its ligamentous apparatus in newborns are more extensible than the spinal cord, which is fixed from above by the medulla oblongata and roots of the brachial plexus, and from below by the cauda equina. Therefore, lesions are most often found in the lower cervical and upper thoracic regions, i.e. in places of greatest mobility and attachment of the spinal cord. Excessive stretching of the spine can cause the brain stem to descend and wedged into the foramen magnum. It should be remembered that the spinal cord during a birth injury can be torn, and the spine is intact and no pathology is detected during an X-ray examination.

Neuromorphological changes in the acute period are reduced mainly to epidural and intraspinal hemorrhages, spinal injuries are very rarely observed - these can be fractures, displacements or detachments of the epiphyses of the vertebrae. In the future, fibrous adhesions are formed between the membranes and the spinal cord, focal zones of necrosis with the formation of cystic cavities, and a violation of the architectonics of the spinal cord.

Clinical manifestations depend on the severity of the injury and the level of the lesion. In severe cases, a picture of spinal shock is expressed: lethargy, adynamia, muscle hypotension, areflexia, diaphragmatic breathing, weak cry. The bladder is distended, the anus gapes. The child resembles a patient with a syndrome of respiratory disorders. The withdrawal reflex is pronounced: in response to a single prick, the leg bends and unbends several times in all joints (oscillates), which is pathognomonic for spinal cord injury. There may be sensory and pelvic disorders. In the future, 2 types of the course of the pathological process are distinguished. Less commonly, the state of spinal shock persists, and children die from respiratory failure. More often, the phenomena of spinal shock gradually regress, but the child still has hypotension for weeks or months.

During this period, it is almost impossible to determine a clear level of damage and, accordingly, the difference in muscle tone above and below the injury site, which is explained by the immaturity of the nervous system, stretching of the spinal cord and roots along the entire length, and the presence of multiple diapedetic hemorrhages. Then hypotension is replaced by spasticity, increased reflex activity. The legs take the position of "triple flexion", a pronounced symptom of Babinsky appears. Neurological disorders in the upper extremities depend on the level of the lesion.

If the structures involved in the formation of the brachial plexus are damaged, hypotension and areflexia persist, if pathological changes are localized in the mid-cervical or upper cervical regions, then spasticity gradually increases in the upper limbs. Vegetative disorders are also noted: sweating and vasomotor phenomena; trophic changes in muscles and bones can be expressed. With a mild spinal injury, transient neurological symptoms are observed due to hemolytic dynamics disorders, edema, as well as changes in muscle tone, motor and reflex reactions.

The diagnosis is established on the basis of information about the obstetric history (birth in breech presentation), clinical manifestations, examination results using nuclear magnetic resonance, electromyography. Spinal cord injury can be combined with spinal injury, so it is necessary to conduct an x-ray of the alleged area of ​​the lesion, the study of cerebrospinal fluid.

Treatment consists of immobilizing the suspected area of ​​injury (cervical or lumbar); in the acute period, dehydration therapy is carried out (diacarb, triamteren, furosemide), antihemorrhagic agents (vikasol, rutin, ascorbic acid, etc.) are prescribed. In the recovery period, an orthopedic regimen, exercise therapy, massage, physiotherapy, electrical stimulation are indicated. Aloe, ATP, dibazol, pyrogenal, B vitamins, galantamine, prozerin, xanthinol nicotinate are used.

If the child does not die in the acute period of spinal cord injury, then the outcome depends on the severity of anatomical changes. With persistent neurological disorders, children need long-term rehabilitation therapy. Prevention involves the correct management of childbirth in the breech presentation (see. Breech presentation fetus) and in case of discoordination of labor activity, prevention of fetal hypoxia, the use of caesarean section in order to exclude hyperextension of its head, the identification of surgically corrected lesions.

Trauma of the peripheral nervous system:

Trauma to the peripheral nervous system includes trauma to the roots, plexuses, peripheral nerves, and cranial nerves. The most common injury is the brachial plexus, phrenic, facial and median nerves. Other variants of traumatic injuries of the peripheral nervous system are less common.

Brachial plexus injury in children:

Brachial plexus paresis occurs as a result of CV-ThI root injury, with an incidence of 0.5 to 2 per 1000 live births. Injury to the brachial plexus (obstetric paresis) is observed mainly in children with a large body weight, born in the breech or foot presentation. The main cause of the injury is obstetric benefits provided when the upper limbs of the fetus are tilted back, the shoulders and head are difficult to remove. Traction and rotation of the head with fixed shoulders and, conversely, traction and rotation of the shoulders with a fixed head lead to tension of the roots of the lower cervical and upper thoracic segments of the spinal cord over the transverse processes of the vertebrae. In the absolute majority of cases, obstetric paresis occurs against the background of fetal asphyxia.

Pathological examination reveals perineural hemorrhages, punctate hemorrhages in the nerve trunks, roots; in severe cases - rupture of the nerves that form the brachial plexus, separation of the roots from the spinal cord, damage to the substance of the spinal cord.

Depending on the localization of damage, paresis of the brachial plexus is divided into upper (proximal), lower (distal) and total types. The upper type of obstetric paresis (Duchenne-Erba) occurs as a result of damage to the upper brachial bundle of the brachial plexus or cervical roots, originating from the CV-CVI segments of the spinal cord. As a result of paresis of the muscles that abduct the shoulder, rotate it outward, raise the arm above the horizontal level, the flexors and supinators of the forearm, the function of the proximal upper limb is impaired.

The child's arm is brought to the body, extended, rotated inward in the shoulder, pronated in the forearm, the hand is in palmar flexion, the head is tilted to the affected shoulder. Spontaneous movements are limited or absent in the shoulder and elbow joints, dorsiflexion of the hand and movements in the fingers are limited; muscle hypotonia is noted, there is no reflex of the biceps of the shoulder. This type of paresis can be combined with trauma to the phrenic and accessory nerves.

Obstetric paresis:

The lower type of obstetric paresis (Dejerine-Klumpke) occurs as a result of a decrease in the middle and lower primary bundles of the brachial plexus or roots, originating from the CVII-ThI segments of the spinal cord. As a result of paresis of the flexors of the forearm, hand and fingers, the function of the distal arm is impaired. Muscular hypotonia is noted; movements in the elbow, wrist joints and fingers are sharply limited; the brush hangs down or is in the position of the so-called clawed paw. In the shoulder joint, movements are preserved. On the paresis side, the Bernard-Horner syndrome is expressed, trophic disorders can be observed, Moro and grasping reflexes are absent, and sensitive disturbances in the form of hypesthesia are observed.

The total type of obstetric paresis is caused by damage to nerve fibers originating from the CV-ThI segments of the spinal cord. Muscular hypotension is pronounced in all muscle groups. The child's arm hangs passively along the body, it can easily be wrapped around the neck - a symptom of a scarf. Spontaneous movements are absent or insignificant. Tendon reflexes are not elicited. The skin is pale, the hand is cold to the touch. Sometimes Bernard-Horner syndrome is expressed. By the end of the neonatal period, as a rule, muscle atrophy develops.

Obstetric paresis is more often unilateral, but can also be bilateral. In severe paresis, along with trauma to the nerves of the brachial plexus and the roots that form them, the corresponding segments of the spinal cord are also involved in the pathological process.

The diagnosis can be established already at the first examination of the newborn on the basis of characteristic clinical manifestations. Electromyography helps to clarify the localization of damage.

Treatment should begin from the first days of life and be carried out continuously in order to prevent the development of muscle contractures and train active movements. The hand is given a physiological position with the help of splints, a splint, massage, exercise therapy, thermal (ozocerite, paraffin, hot wraps) and physiotherapy (electrical stimulation) procedures are prescribed; medicinal electrophoresis (potassium iodide, prozerin, lidase, aminophylline, nicotinic acid). Drug therapy includes B vitamins, ATP, dibazol, proper-mil, aloe, prozerin, galantamine.

With timely and proper treatment, limb functions are restored within 3-6 months; the recovery period for paresis of moderate severity lasts up to 3 years, but often the compensation is incomplete, severe obstetric paralysis leads to a permanent defect in hand function. Prevention is based on rational, technically competent management of childbirth.

Diaphragm paresis (Cofferat's syndrome):

Diaphragm paresis (Cofferat's syndrome) - restriction of diaphragm function as a result of damage to the CIII-CV roots of the phrenic nerve with excessive lateral traction during childbirth. Diaphragm paresis may be one of the symptoms of congenital myotonic dystrophy. It is clinically manifested by shortness of breath, rapid, irregular or paradoxical breathing, repeated bouts of cyanosis, bulging of the chest on the side of the paresis. In 80% of patients, the right side is affected, bilateral damage is less than 10%. Diaphragmatic paresis is not always clinically evident and is often detected only on chest x-ray. The dome of the diaphragm on the side of the paresis is high and slightly mobile, which in newborns can contribute to the development of pneumonia. Diaphragmatic paresis is often associated with brachial plexus injury.

Diagnosis is based on a combination of characteristic clinical and radiological findings.

Treatment is to ensure adequate ventilation of the lungs until spontaneous breathing is restored. The child is placed in a so-called rocking bed. If necessary, carry out artificial ventilation of the lungs, transcutaneous stimulation of the phrenic nerve.

The prognosis depends on the severity of the lesion. Most children recover within 10-12 months. Clinical recovery may occur before radiological changes disappear. With bilateral lesions, mortality reaches 50%.

Paresis of the facial nerve:

Paresis of the facial nerve - traumatic injury during childbirth of the trunk and (or) branches of the facial nerve. It occurs as a result of compression of the facial nerve by the promontorium of the sacrum, obstetric forceps, with fractures of the temporal bone. In the acute period, edema and hemorrhage in the sheaths of the facial nerve are detected.

The clinical picture is characterized by asymmetry of the face, especially when crying, expansion of the palpebral fissure (lagophthalmos, or "hare's eye") When crying, the eyeballs can move upward, and in a loosely closed palpebral fissure, a protein shell is visible - Bell's phenomenon. The corner of the mouth is lowered in relation to the other, the mouth is shifted to the healthy side. Rough peripheral paresis of the facial nerve can make sucking difficult.

Diagnosis is based on characteristic clinical symptoms. Differential diagnosis is carried out with congenital aplasia of the nuclei of the trunk (Mobius syndrome), subdural and intracerebellar hemorrhages in the posterior cranial fossa, central paresis of the facial nerve, brain contusion, in which there are other signs of damage to the nervous system.

The course is favorable, recovery often proceeds quickly and without specific liver. With a deeper lesion, ozocerite, paraffin and other thermal procedures are applied. Consequences (synkinesia and contractures) rarely develop.

Injury to the pharyngeal nerve:

Injury to the pharyngeal nerve is observed when the intrauterine position of the fetus is incorrect, when the head is slightly rotated and tilted to the side. Similar movements of the head can also occur during childbirth, leading to paralysis of the vocal cords. Lateral flexion of the head with a solid thyroid cartilage causes compression of the upper branch of the pharyngeal nerve and its lower recurrent branch. As a result, when the upper branch of the pharyngeal nerve is damaged, swallowing is disturbed, and when the lower recurrent branch is damaged, the closure of the vocal cords, which leads to dyspnea. The rotation of the head causes the face to be pressed against the walls of the pelvis of the woman in labor, so the facial nerve can be injured on the opposite side. If the lateral flexion of the neck is expressed, then damage to the phrenic nerve can be observed and, accordingly, paresis of the diaphragm occurs.

Diagnosis is based on direct laryngoscopy.

The treatment is symptomatic, in severe cases it is necessary to feed through a tube, the imposition of a tracheostomy. Noisy breathing and the threat of aspiration may persist during the first year of life and beyond. The prognosis is often favorable. Recovery usually occurs by 12 months. life.

Median nerve injury:

Injury to the median nerve in newborns can be in 2 places - in the antecubital fossa and in the wrist. Both types are associated with percutaneous puncture of the arteries (brachial and radial, respectively).

The clinical picture in both cases is similar: the finger grip of the object is disturbed, which depends on the flexion of the index finger and abduction and opposition thumb brushes. The position of the hand is characteristic, due to the weakness of flexion of the proximal phalanges of the first three fingers, the distal phalanx of the thumb, and also associated with the weakness of abduction and opposition of the thumb. There is atrophy of the eminence of the thumb.

Diagnosis is based on characteristic clinical symptoms. Treatment includes the imposition of splints on the hand, exercise therapy, massage. The prognosis is favorable.

Radial nerve injury:

Injury to the radial nerve occurs when the shoulder is fractured with nerve compression. This can be caused by an incorrect intrauterine position of the fetus, as well as a difficult course of childbirth. It is clinically manifested by fatty necrosis of the skin above the epicondyle of the beam, which corresponds to the compression zone, weakness of extension of the hand, fingers and thumb (dangling of the hand). The differential diagnosis is carried out with an injury to the lower sections of the brachial plexus, however, with damage to the radial nerve, the grasping reflex and the function of other small muscles of the hand are preserved. The prognosis is favorable, in most cases the function of the hand is quickly restored.

Injury to the lumbosacral plexus:

Injury to the lumbosacral plexus occurs as a result of damage to the roots of LII-LIV and LIV-SIII during traction in a purely breech presentation; is rare. Characterized by total paresis lower limb; extension in the knee is especially disturbed, there is no knee reflex. Differentiate with sciatic nerve injury and dysraphic status. In the latter, skin and bone abnormalities are observed and the lesion is rarely limited to only one limb. The prognosis is often favorable, and only mild motor impairment may persist after 3 years.

Sciatic nerve injury in newborns:

Injury to the sciatic nerve in newborns occurs as a result of improper intramuscular injections into the gluteal region, as well as the introduction of hypertonic solutions of glucose, analeptics, calcium chloride into the umbilical artery, resulting in the development of spasm or thrombosis of the inferior gluteal artery, which supplies blood to the sciatic nerve. It is manifested by a violation of the abduction of the hip and limitation of movement in the knee joint, sometimes there is necrosis of the muscles of the buttocks. In contrast to the injury to the lumbosacral plexus, flexion, adduction, and external rotation of the hip were preserved.

The diagnosis is based on anamnesis data, characteristic clinical symptoms, determination of the speed of the impulse along the nerve. Differentiation should be with trauma to the peroneal nerve. Treatment includes the imposition of splints on the foot, massage, exercise therapy, thermal procedures, drug electrophoresis, electrical stimulation. The prognosis may be unfavorable in cases of improper intramuscular administration of drugs (long recovery period). With paresis of the sciatic nerve resulting from thrombosis of the gluteal artery, the prognosis is favorable.

Peroneal nerve injury:

Peroneal nerve injury occurs as a result of intrauterine or postnatal compression (with intravenous administration of solutions). The site of injury is the superficial part of the nerve located around the head of the fibula.

Hanging foot is characteristic, caused by weakness in the dorsiflexion of the lower leg as a result of damage to the peroneal nerve. The diagnosis is based on typical clinical manifestations and determination of the speed of the impulse along the nerve. Treatment is the same as for a sciatic nerve injury. The prognosis is favorable, recovery in most cases is observed within 6-8 months.

Tactics of managing children with birth trauma of the central and peripheral nervous system. These children are at risk of developing neurological and mental disorders of varying severity in the future. Therefore, they should be put on dispensary records and in the first year of life every 2-3 months. undergo examinations by a pediatrician and a neuropathologist. This will make it possible to timely and adequately carry out medical and corrective measures at the early stages of development.

Treatment of cerebral palsy in children:

Treatment of children with cerebral palsy and severe movement disorders after a brachial plexus injury should be carried out continuously for many years until the maximum compensation of the defect and social adaptation are achieved. Parents take an active part in the treatment of the child from the first days of life. They should be explained that the treatment of a child with damage to the nervous system is a long process, not limited to certain courses of therapy, it requires constant training with the child, during which motor, speech and mental development is stimulated. Parents should be taught the skills of specialized care for a sick child, the basic methods of therapeutic exercises, massage, orthopedic regimen, which should be performed at home.

Mental disorders in children who have suffered a birth injury of the nervous system are expressed by various manifestations of a psycho-organic syndrome, which in the long-term period of a birth traumatic brain injury in children corresponds to an organic defect in the psyche. The severity of this defect, as well as neurological symptoms, is associated with the severity and localization of brain damage (mainly hemorrhages). It consists in intellectual insufficiency, convulsive manifestations and psychopathic features of behavior. In all cases, cerebrasthenic syndrome is necessarily detected. Various neurosis-like disorders can also be observed, occasionally psychotic phenomena occur.

Intellectual deficiency in birth trauma of newborns associated with damage to the nervous system manifests itself primarily in the form of oligophrenia. A distinctive feature of such an oligophrenia is the combination of mental underdevelopment with signs of an organic decline in personality (more severe impairment of memory and attention, exhaustion, complacency and uncriticality), convulsive seizures and psychopathic behavioral features are not uncommon. In milder cases, intellectual deficiency is limited to secondary mental retardation with a picture of organic infantilism.

With encephalopathy with a predominance of convulsive manifestations, various epileptiform syndromes, asthenic disorders and decreased intelligence are observed.

Among the long-term consequences of traumatic brain injury in children, psychopathic behavioral disorders with increased excitability, motor disinhibition, and the detection of gross drives have a significant distribution. The cerebrosthenic syndrome is the most constant and characteristic, it manifests itself in the form of protracted asthenic conditions with neurosis-like disorders (tics, fears, anuresis, etc.) and signs of an organic mental decline. Psychotic disorders are observed rarely, in the form of episodic or periodic organic psychosis.

General distinguishing feature mental disorders in birth traumatic brain injury (except for oligophrenia) consists in the lability of symptoms and the relative reversibility of painful disorders, which is associated with a generally favorable prognosis, especially with adequate treatment, which is mainly symptomatic and includes dehydration, absorbable, sedative and stimulating ( nootropics) therapy. Psycho-correctional and medical-pedagogical measures are essential.

Prevention is associated with the prevention of complications, improvement of care for pregnant women and obstetric care.