Cranial Birth Injuries in Term Newborn Infants

Abstract

While cranial birth injuries in term infants are well recognized, to date, only small case series have been described. In an attempt to further define the spectrum of cranial birth injuries, we analyzed 41 consecutive cranial birth injuries at our institution over the period 1991–1998. The most common clinical presentations were apnea (39%) and seizures (37%). Average Apgar scores were 5.7 at 1 min and 7.3 at 5 min; 54% of infants had abnormally low Apgar scores at 1 min and 31% had abnormally low scores at 5 min. The most common intracranial lesion was subdural hemorrhage, present in 73% of infants; most had either a tentorial (57%) and/or interhemispheric (50%) location. Operative treatment was required in 5 infants (12%). Two of the 41 infants (4.8%) died. The study group was compared with a control group of 63 randomly selected births without cranial injury. Using a stepwise logistic regression model, independently significant variables included neonatal birth weight, Apgar scores at 1 and 5 min and mode of delivery. Compared with the controls, the study group had a significantly higher incidence of forceps and/or vacuum deliveries. Combining vacuum, forceps and urgent cesarean section deliveries together as ‘urgent’ and elective cesarean and spontaneous vaginal deliveries as ‘nonurgent’, we could find no significant differences between these two groups. Our data conflict with those of Towner et al. [N Engl J Med 1999;341:1709–1714], and suggest that the method of assisted delivery, rather than the urgency of the delivery or dysfunctional labor per se, is a more important variable in cranial birth injuries.

Mast cells in the human dura: effects of age and dural bleeding

“…SDH is known to be common in infants with cranial birth injury [13], but there is an increasing awareness that it is also common in asymptomatic neonates, with estimates of incidence ranging from 8% [16] to 46% [14]. It is generally considered that birthrelated SDH is reabsorbed by 1 month of age, based on imaging studies [25].…”

Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants

“…Proposed mechanisms for SDH have included tears of the falx and tentorium or bridging cortical veins secondary to stretching, 11 difficult delivery, 26,27 or abnormal labor. 19 One suggested mechanism of hemorrhage after vaginal delivery is that increased circumferential pressure and squeezing of the head in the birthing canal result in overlap at the sutures, mechanical compression, and shearing of the bridging veins during delivery, resulting in SDH.…”

“…29, 30 Towner et al 19 suggested that abnormal labor was a common risk factor for hemorrhage in infants, after a retrospective review of deliveries in nulliparous women demonstrated a low incidence of intracranial hemorrhage. Pollina et al 27 suggested that the method of assisted delivery rather than the urgency of the delivery or dysfunctional labor is a more important variable in cranial birth injuries. Although all types of intracranial hemorrhage were more common in vacuum extraction, not all term neonate SDHs can be explained by circumferential head squeeze and overlapping sutures.…”

“…Although all of these factors or a combination of these factors is plausible for the mechanism, SDH as a product of parturition has now been documented in asymptomatic neonates in multiple studies. [14][15][16][17][18][19][20][21][22][23][26][27][28] Although most of the asymptomatic SDHs seen at MR imaging and US were in neonates delivered vaginally, 18% (4 of 22) of our neonates delivered by cesarean birth also had SDH. Most infants with SDH delivered by cesarean birth (75%) had a trial of labor with oxytocin administration before the cesarean delivery.…”

Vacuum assisted birth and risk for cerebral complications in term newborn infants: a population-based cohort study

“…VE is reported to be associated with rare but severe cerebral complications [9], although study limitations have been small sample size and retrospective design [9,10], composite outcomes [11], mixed term and preterm deliveries [12,13], no comparisons of rates of intracranial complications in vacuum extraction and caesarean section (CS) deliveries [9,13]. In addition, few studies have investigated the association between VE and neonatal encephalopathy and the results are contradictive [13,14].…”