Central nervous system injuries
Brain disorders are most commonly provoked by hypoxia, whereas traumatic hemorrhages are diagnosed less frequently. Intracranial hematomas are classified into epidural, subdural, subarachnoid, and intracerebral.
Clinical manifestations develop in two phases:
- Excitation phase: characterized by restless crying, tachycardia, tachypnea, tremor, and seizures.
- Depression phase: follows excitation and presents with lethargy, muscular hypotonia, pallor, adynamia, and a drop in blood pressure.
A particularly severe condition is a cerebellar tentorium tear, leading to intracranial hypertension, a comatose state, and respiratory depression. Neurosonography is actively used to visualize CNS pathologies.
Peripheral nervous system and skeletal birth injuries
Incorrect or excessive manual assistance, head rotation, and the use of obstetrical forceps can lead to peripheral nerve and bone injuries.
- Facial nerve: paresis manifests as facial asymmetry during crying; function typically recovers within the first month.
- Brachial plexus: injuries are divided into upper (Erb-Duchenne), lower (Dejerine-Klumpke) paralysis, and total palsy.
- Cephalhematoma: subperiosteal hemorrhage characterized by palpable fluctuation and a firm ridge along the edge.
- Bone fractures: fractures of the clavicle, humerus, and femur are accompanied by bone fragment crepitus and swelling, and require fixation treatment.
Respiratory distress syndrome and pneumopathies
Respiratory failure in newborns is frequently associated with respiratory distress syndrome (RDS), caused by immaturity of the pulmonary surfactant system. Surfactant deficiency leads to alveolar collapse during expiration, causing hypoxemia and hypercapnia.
Aggravating factors include:
- Fetal intrauterine hypoxia, causing pulmonary vasoconstriction.
- Aspiration of amniotic fluid or meconium.
- Delayed resorption of fetal fluid.
Manifestations of respiratory disorders include hyaline membrane disease, edema-hemorrhagic syndrome, and pulmonary atelectasis—areas of unexpanded lung tissue persisting for more than 48 hours.
Briefly: answers to topical questions
How does a cephalhematoma differ from a caput succedaneum?
A cephalhematoma and a caput succedaneum differ in the localization of the pathological process and their relationship to the cranial sutures.
| Sign | Caput succedaneum | Cephalhematoma (Cephalohaematoma) |
|---|---|---|
| Essence of the process | Edema of subcutaneous tissue and subcutaneous hemorrhages | Accumulation of blood beneath the periosteum (subperiosteal hemorrhage) |
| Localization | Superficial (between the skin and periosteum) | Between the skull bone and periosteum |
| Relationship to sutures | Not limited by sutures | Strictly limited to the boundaries of a single bone |
| Clinical presentation | Usually of no clinical significance | Fluctuation, with a firm ridge palpable at the base |
What Apgar score criteria are used to assess the severity of neonatal asphyxia?
The severity of asphyxia is assessed using five clinical criteria of the Apgar scale:
- Appearance (Appearance) — skin coloration.
- Pulse (Pulse) — heart rate.
- Grimace (Grimace) — reflex irritability in response to stimulation.
- Activity (Activity) — muscle tone and presence of spontaneous movements.
- Respiration (Respiration) — presence and character of respiratory movements.
Severe asphyxia is diagnosed at a score of 0–3, moderate asphyxia at 4–5, and mild asphyxia at 6–7.
What specific neurological and orthopedic symptoms indicate a clavicle fracture in a newborn?
A clavicle fracture in a newborn presents with local orthopedic signs as described in sources; specific neurological signs are not reported.
The clinical picture includes:
- Restlessness — occurs when swaddling the infant.
- Swelling — determined over the fracture site.
- Crepitus — detected upon palpation of the bone fragments.
- Callus — the injury may be identified by its formation on days 5–7, as the fracture often remains undiagnosed during the first days.
What is the algorithm for initial neonatal resuscitation in severe asphyxia in the delivery room?
The neonatal initial resuscitation algorithm is based on a strict ABC sequence.
- Airways (Airways) — initial stage of restoring patency; endotracheal intubation is mandatory in case of meconium-stained amniotic fluid aspiration.
- Breathing (Breathing) — performing artificial lung ventilation.
- Circulation (Circulation) — chest compressions.
Basic resuscitation is performed in a strict ratio: the compression-to-ventilation ratio is 3:1 (90 compressions and 30 breaths per minute are required). In severe asphyxia, cerebral hypothermia is also included in the treatment complex.
Class and exam questions
What is the main cause of intracranial hemorrhage in newborns?
The most frequent cause of brain injury is hypoxia, whereas purely traumatic hemorrhages occur relatively rarely.
What are the clinical phases of central nervous system injury in hypoxia and trauma?
In the acute period, an excitation phase with seizures and tachycardia is observed, which is followed by a depression phase characterized by muscular hypotonia, lethargy, and absent sucking reflex.
Why do premature infants develop respiratory distress syndrome?
RDS develops due to the immaturity and deficiency of alveolar surfactant, the synthesis of which normally concludes only by the 35th–36th week of gestation.
What else to study on this topic
- Pathogenesis and diagnosis of cerebellar tentorial tear
- Comparison of Erb-Duchenne and Klumpke paralysis
- Treatment methods and repositioning for tubular bone fractures
- Pathomorphology of pulmonary hyaline membranes
- Role of lumbar puncture in the diagnosis of intracranial hemorrhages
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