Patrimonial trauma of newborns – various damages of a fruit arising in the course of the patrimonial act. Damages of soft fabrics (skin, hypodermic cellulose, muscles), bone system, internals, the central and peripheral nervous system occur among patrimonial injuries of newborns. The patrimonial trauma of newborns is diagnosed taking into account the obstetric and gynecologic anamnesis of mother, features of a course of childbirth, the given survey of the newborn and additional researches (EEG, ultrasonography, a X-ray analysis, an oftalmoskopiya, etc.). Treatment of patrimonial injuries of newborns is carried out differentially taking into account a look and weight of damage.
Patrimonial trauma of newborns
Understand the violation of integrity of fabrics or bodies of the child caused by the mechanical forces operating in process of childbirth as a patrimonial trauma of newborns. Patrimonial injuries are diagnosed for 8-11% of newborns. Patrimonial injuries of newborns are quite often combined with patrimonial injuries of mother (ruptures of a vulva, vagina, crotch, uterus, urinogenital and vaginal fistulas, etc.). Patrimonial injuries of newborns can exert serious impact on further physical health and intellectual development of the child. All this does rodovy traumatism of one of the most urgent problems of obstetrics and gynecology, a neonatology and pediatrics, children's neurology and traumatology.
Classification of a patrimonial trauma of newborns
Depending on localization of damage and primary violation of functions allocate the following types of a patrimonial trauma of newborns:
1. Patrimonial injuries of soft fabrics (skin, hypodermic cellulose, muscles, patrimonial tumor, kefalogematoma).
2. Patrimonial injuries of bone and articulate system (cracks and fractures of a clavicle, humeral and femurs; traumatic humeral bone, incomplete dislocation of joints of C1 and C2, injury of bones of a skull, etc.)
3. Patrimonial injuries of internals (hemorrhage in internals: liver, spleen, adrenal glands).
4. Patrimonial injuries of the central and peripheral nervous system at newborns:
- intra cranial patrimonial trauma (epiduralny, subduralny, subarakhnoidalny, intraventrikulyarny hemorrhages)
- patrimonial injury of a spinal cord (hemorrhage in a spinal cord and its covers)
- patrimonial trauma of peripheral nervous system (damage of a humeral texture - paresis/paralysis of Dyushena-Erba or paralysis Dezherin-Klyumpka, total paralysis, diaphragm paresis, injury of a facial nerve, etc.).
Reasons of a patrimonial trauma of newborns
The analysis of the reasons of a patrimonial trauma of newborns allows to allocate three groups of the factors increasing probability of its emergence: belonging to mother, to a fruit, and also to a current and conducting childbirth.
As the contributing "maternal" factors early or late reproductive age, gestoza, a narrow basin, a hypoplasia or a giperantefleksiya of a uterus, a disease of the pregnant woman (cardiovascular, endocrine, gynecologic, etc.), perenoshenny pregnancy, professional harm etc. can act.
The most extensive group of the reasons leading to a patrimonial trauma of newborns is made by the circumstances connected with a fruit. Pelvic prelying of a fruit, lack of water, wrong (asinklitichesky or razgibatelny insertion of a head), prematurity, the large sizes of a fruit, anomaly of development of a fruit, a pre-natal hypoxia and asphyxia, etc. can provoke a patrimonial trauma.
Can lead anomalies of patrimonial activity to developing of a patrimonial trauma of the newborn: the long or bystry childbirth, a rodostimulyation at weak patrimonial activity dicoordinated or excessively strong patrimonial activity. The serious group of the reasons of patrimonial injuries of newborns is made by the wrong or unreasonable application of obstetric grants (turn of a fruit on a leg, imposing of obstetric nippers, use of a vacuum extractor, performing Cesarean section, etc.).
As a rule, when developing patrimonial injuries of newborns the combination of a number of the adverse factors breaking normal biomechanics of childbirth takes place.
Patrimonial injuries of newborns: symptoms, diagnostics, treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Patrimonial injuries of soft fabrics
The most frequent manifestations of patrimonial traumatism of newborns are injuries of skin and hypodermic cellulose. Scratches, grazes, petekhiya, ekhimoza on various parts of the body concern to them. Such damages come to light at visual survey of the newborn neonatology; usually they are not dangerous and demand only local antiseptic processing and imposing of an aseptic bandage. Insignificant patrimonial injuries of soft fabrics disappear by the end of the first week of life of the newborn.
Kind of a patrimonial trauma of newborns is the patrimonial tumor which is characterized by a local swelling of soft tissues of the head. The patrimonial tumor has a myagkoelastichesky consistence, cyanotic color with multiple petekhiya and ekhimoza. Its emergence is usually connected with long childbirth in head prelying or imposing of obstetric nippers. The patrimonial tumor of treatment does not demand, disappears independently in 1-3 days.
As heavier type of a patrimonial trauma of newborns serves damage (hemorrhage, a gap) - a clavicular and mastoidal muscle, usually its lower third. In this case in the place of damage the small tumor of moderately dense or pasty consistence is defined. Damage - a clavicular and mastoidal muscle can be revealed not at once, and approximately in a week when at the child the wryneck develops. In treatment of a patrimonial trauma - a clavicular and mastoidal muscle at newborns corrective position of the head by means of rollers, dry heat, an electrophoresis of iodide potassium, massage is used; at inefficiency – surgical correction.
Kefalogematoma as kind of a patrimonial trauma of newborns, is characterized by hemorrhage under a periosteum parietal or occipital skull bones. The elastic consistence, lack of a pulsation, painlessness, fluctuation, existence of the roller on the periphery are typical signs of a kefalogematoma. Further at newborns from kefalogematomy the jaundice caused by the increased extra vascular formation of bilirubin can be noted. Kefalogematoma decreases in sizes by 2-3 week of life, and completely resolves by the outcome 6-8 weeks. Anemia, calcification and suppuration of a kefalogematoma belongs to complications of a podnadkostnichny patrimonial trauma of newborns. Children with big (more than 6 cm in the diameter) kefalogematomam need carrying out a X-ray analysis of a skull for an exception of cracks of bones. As at premature children of a kefalogematoma are often associated with pre-natal mycoplasmosis, carrying out PTsR or IFA of diagnostics is required.
In most cases patrimonial injuries of soft fabrics at newborns pass without consequences.
Patrimonial injuries of bone system
Among patrimonial injuries of bone and articulate system at newborns injuries of a clavicle and bones of extremities meet more often. They always treat purely obstetric types of damages. Podnadkostnichny fractures of a clavicle without shift usually are found in 3-4 days after the delivery on existence of a spindle-shaped dense swelling - the formed bone callosity. The fracture of clavicles with shift is followed by impossibility of performance of active movements, pain, we cry at the passive movement of a hand, a swelling and a krepitation over the place of a change.
At a change humeral or a femur there are no active movements in extremities, there is a painful reaction to the passive movements, there is hypostasis, deformation and shortening of the injured extremity. At any kinds of changes newborns need consultation of the children's traumatologist, performing radiological diagnostics (a X-ray analysis of a clavicle, a X-ray analysis of tubular bones). At a fracture of a clavicle the short-term immobilization of a hand by imposing of a bandage of Dezo or dense swaddling is carried out. At fractures of humeral and femoral bones the repozition of bones of the top or lower extremity and imposing of a plaster bandage is carried out (if necessary – extension).
Kind of a patrimonial trauma of bone system of newborns is traumatic a humeral bone. As its manifestations serve morbidity, a swelling and a krepitation in humeral or elbow joints, restriction of volume of movements in the affected hand. Paresis of a beam nerve, formation of a sgibatelny contracture in joints can be an outcome of a similar trauma. Treatment consists in an extremity immobilization, holding physiotherapeutic procedures, massage.
Patrimonial injuries of internals
Internal injuries arise owing to mechanical impact on a fruit at the abnormal course of childbirth. Most often hemorrhages in a liver, a spleen and adrenal glands meet. Clinical displays of a patrimonial injury of internals at newborns develop for 3-5 days in connection with internal bleeding. At a rupture of a hematoma there is an abdominal distension, intestines paresis, muscular hypotonia (or an atoniya), oppression of physiological reflexes, arterial hypotonia, persistent vomiting and vomiting develops.
At suspicion of a patrimonial injury of internals by the newborn the survey X-ray analysis of an abdominal cavity, ultrasonography of abdominal organs and ultrasonography of adrenal glands is made. Treatment consists in performing haemo static and symptomatic therapy; if necessary – laparoscopies or laparotomies with audit of internals.
At hemorrhage sharp or chronic nadpochechnikovy insufficiency can develop in adrenal glands at the child. The forecast at a patrimonial injury of internals at newborns is defined by the volume and weight of defeat, timeliness of identification of damage.
Patrimonial injuries of the central and peripheral nervous system
Damages of nervous system at newborns make the most extensive group of patrimonial injuries. Within this review we will stop on a patrimonial injury of a spinal cord and peripheral nervous system; the detailed characteristic of intra cranial patrimonial injuries of newborns will be given in the relevant article.
Patrimonial injuries of a spinal cord at newborns can include the hemorrhage, stretching, a sdavleniye or a rupture of a spinal cord at various level connected with spinal fracture or arising without it. Heavy damages are characterized by clinic of spinal shock: slackness, muscular hypotonia, arefleksiya, weak shout, diafragmalny breath. Death of children can occur from respiratory insufficiency. In more opportunities there is a gradual regress of the phenomena of spinal shock; hypotonia is succeeded by a spastika; vegetative violations (vasomotorial reactions, perspiration), trophic changes in a muscular and bone tissue develop. Patrimonial injuries of easy degree at newborns are followed by passing neurologic symptomatology: change of a tone of muscles, reflex and motive reactions.
Diagnosis is promoted by survey of the child by the children's neurologist, carrying out a X-ray analysis or MRT of a backbone, an electromyography, lyumbalny puncture and a research of tserebrospinalny liquid. Treatment of a patrimonial injury of spinal cord at newborns includes an immobilization of field of damage, performing dehydrational and antihemorrhagic therapy, recovery actions (orthopedic massage, LFK, electrostimulation, physical therapy).
Patrimonial injuries of peripheral nervous system at newborns unite damages of backs, textures, peripheral and cranial nerves.
Taking into account localization paresis of a humeral texture (obstetric paresis) can be top (proximal), lower (disteel) or total. The top paresis of Dyushenna-Erba is connected with damage of the textures and backs originating in C5-C6 segments that is followed by malfunction of proximal department of the top extremity. In this case the child accepts characteristic situation with the hand given to a trunk, unbent in an elbow joint, turned inside in a shoulder and pronirovanny in a forearm; the brush bent in a palm and the head inclined to a sore shoulder.
At the lower obstetric paresis of Dezherin-Klyumpka the textures or backs originating from C7-T1 are surprised, as the investigation of what serves malfunction of disteel department of a hand. Manifestations include muscular hypotonia, gipesteziya, restriction of movements in luchezapyastny and elbow joints, hand fingers, a symptom of "a sharp-clawed paw". At total type of obstetric paresis the hand completely stays idle, muscular hypotonia is sharply expressed, the atrophy of muscles early develops.
The diagnosis and localization of damage is specified by means of an electromyography. Treatment of a patrimonial trauma of a humeral texture at newborns consists in a hand immobilization with the help steaks, performing massage, LFK, physiotherapy (applications of ozokerite, paraffin, electrostimulation, an electrophoresis), medicinal therapy.
At diaphragm paresis at the newborn short wind, paradoxical breath, cyanosis, a vybukhaniye of a chest cage on the struck party develops. Detection of paresis is promoted by roentgenoscopy and a X-ray analysis of a thorax at which high standing and low-mobility of a dome of a diaphragm is defined. On this background at children stagnant pneumonia can develop. Treatment of a patrimonial trauma consists in chreskozhny stimulation of a diafragmalny nerve; if necessary – IVL before restoration of adequate independent breath
Paresis of a facial nerve is connected about damage of a trunk or branches of a facial nerve. In this case at the child asymmetry of the person, , eyeball shift is noted up at shout, asymmetry of a mouth, sucking difficulty. The patrimonial trauma is diagnosed for newborns on the basis of clinical signs, elektroneyrografiya, registration of the caused potentials. Quite often paresis of a facial nerve passes without special treatment; in other cases heattreatment, medicamentous therapy is carried out.
Injuries of a pharyngeal, median, beam, sciatic, peronealny nerve, lumbar and sacral texture belong to more rare species of patrimonial injuries of newborns.
Prevention of a patrimonial trauma of newborns
Prevention of patrimonial injuries at newborns assumes assessment of degree of risk of their emergence at a stage of conducting pregnancy, the most careful attitude to the child in the course of childbirth, refusal of unreasonable use of grants on extraction of a fruit and operational rodorazresheniye.