Mechanical birth-related trauma to the neonate: An imaging perspective

Abstract

Mechanical birth-related injuries to the neonate are declining in incidence with advances in prenatal diagnosis and care. These injuries, however, continue to represent an important source of morbidity and mortality in the affected patient population. In the United States, these injuries are estimated to occur among 2.6% of births. Although more usual in context of existing feto-maternal risk factors, their occurrence can be unpredictable. While often superficial and temporary, functional and cosmetic sequelae, disability or even death can result as a consequence of birth-related injuries. The Agency for Healthcare research and quality (AHRQ) in the USA has developed, through expert consensus, patient safety indicators which include seven types of birth-related injuries including subdural and intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, peripheral and cranial nerve injuries and other types of specified and non-specified birth trauma. Understandably, birth-related injuries are a source of great concern for the parents and clinician. Many of these injuries have imaging manifestations. This article seeks to familiarize the reader with the clinical spectrum, significance and multimodality imaging appearances of neonatal multi-organ birth-related trauma and its sequelae, where applicable. Teaching points • Mechanical trauma related to birth usually occurs with pre-existing feto-maternal risk factors.• Several organ systems can be affected; neurologic, musculoskeletal or visceral injuries can occur.• Injuries can be mild and transient or disabling, even life-threatening.• Imaging plays an important role in injury identification and triage of affected neonates.Electronic supplementary materialThe online version of this article (10.1007/s13244-017-0586-x) contains supplementary material, which is available to authorized users.

Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study

“…The majority of ICHs in our study were small extra-axial or petechial parenchymal hemorrhages localized in the posterior fossa, but there also were multifocal hemorrhages with various patterns of bleeding. The origin of the observed hemorrhages may be related to delivery [45] or to the cooling itself [11, 12], and while the cooling-induced thrombocytopenia [6] may potentially lead to a progression of these bleedings, we have no evidence of progression in our data, partly due to a lack of follow-up imaging. Nevertheless, progression seems to be unlikely given the fact that these ICHs proved to have no significant modulatory effect on the long term mental (MDI) and psychomotor (PDI) developmental outcome.…”

Perinatal Femoral Fracture: A Ten-Year Observational Case Series Study

“…PFF is a rare trauma in neonatology units [ 14 ]. A Portuguese study of 7364 newborns found 76 fractures related to birth trauma.…”

“…In every case, the fracture diagnosis was made after a clinical examination and X-ray. All fractures were treated similarly: Bryant’s skin traction of the affected leg(s) with hip flexion of 90° with the infant’s buttock(s) elevated 1 cm from the cot (weight around 200 g) for 15 days [ 13 , 14 ] ( Figure 1 ).…”

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“…4 In the United States, the estimated rate of mechanical birth-related injuries is 2.6%. 5 The rates of birth trauma may vary in different countries [3][4][5][6] and also institutions within the country. A study from India reported incidence of 15.4 per 1000 cases of live births.…”