RESUMEN
Birth Brachial plexus injury continues to remain a problem despite significant care from obstetricians to prevent it. Many children show spontaneous recovery but a significant proportion do not have adequate recovery. This review article discusses, etiology, assessment, investigations and overall strategy to treat the condition. Surgical strategy consists of primary intraplexal repair as the standard of care but of late the distal nerve transfers used in adult plexus injuries are increasingly being used in infants too. We discuss the history, current usage and pros and cons of distal nerve transfers, the usage of Botulinum Toxin and finally given an overall algorithm for the management.
Asunto(s)
Traumatismos del Nacimiento/cirugía , Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/cirugía , Algoritmos , Traumatismos del Nacimiento/clasificación , Plexo Braquial/lesiones , Neuropatías del Plexo Braquial/clasificación , Electrodiagnóstico , Humanos , Transferencia de Nervios , Nervios Periféricos/trasplante , Examen FísicoRESUMEN
Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.
Asunto(s)
Traumatismos del Nacimiento , Intervención Médica Temprana/métodos , Urgencias Médicas , Complicaciones del Trabajo de Parto , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/epidemiología , Salas de Parto/organización & administración , Femenino , Humanos , Recién Nacido , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/terapia , Embarazo , Medición de Riesgo/métodos , Factores de Riesgo , Tiempo de TratamientoRESUMEN
Brachial plexus birth injuries are rare, with treatment and follow-up often required from infancy until skeletal maturity. We review complications that may occur related to primary nerve surgery or secondary musculoskeletal procedures, and discuss how these may be avoided.
Asunto(s)
Traumatismos del Nacimiento/cirugía , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Complicaciones Posoperatorias/terapia , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/diagnóstico , Contractura/etiología , Contractura/terapia , Errores Diagnósticos , Humanos , Cuidados Intraoperatorios , Examen Físico , Cuidados Posoperatorios , Cuidados Preoperatorios , Rango del Movimiento Articular/fisiología , Extremidad Superior/fisiopatologíaRESUMEN
OBJECTIVE: The most common birth-associated head injuries during vaginal delivery are cephalhematomas and subgaleal hematomas. Cranial injuries are rarely encountered. The neonate cranium is soft and pliable, and greenstick skull fractures (GSFs) are expected to be more frequent than linear or depressed fractures, but they are extremely difficult to detect with simple skull radiography. As a result, no reports have been issued on this topic to date. Recent reports suggest that technological advances in 3-dimensional (3D) computed tomography (CT) have successfully enhanced the diagnostic accuracy for cranial fractures. The authors researched the types and characteristics of GSFs and the diagnostic accuracy of 3D CT for cranial fractures in neonates. METHODS: The simple skull radiographs and 3D CT images of 101 neonates were retrospectively evaluated and compared with respect to diagnosis of cranial fractures, and skull GSFs were classified on the basis of 3D CT findings into 5 types depending on multiplicity and location. RESULTS: 3D CT detected 88 cases of cranial fractures, that is, 89 GSFs, 4 combined GSFs and linear fractures, and 3 combined GSFs and depressed fractures. The diagnostic rate of 3DCT was 91% and this was significantly higher than the 13% rate of simple skull radiographs (P < 0.001). CONCLUSIONS: GSFs rather than linear fractures were found to account for most cranial injuries among neonates. The diagnostic accuracy of 3D CT was considerably superior than simple skull radiography, but the high radiation exposure levels of 3D CT warrant the need for development of a modality with lower radiation exposure.
Asunto(s)
Traumatismos del Nacimiento/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Fractura Craneal Deprimida/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , Fractura Craneal Deprimida/clasificación , Fractura Craneal Deprimida/epidemiología , Fracturas Craneales/clasificación , Fracturas Craneales/epidemiologíaRESUMEN
BACKGROUND: The Mallet scale, Active Movement Scale (AMS), and Toronto Test are validated for use in children with brachial plexus birth palsy (BPBP). However, the inability to compare these evaluation systems has led to difficulty gauging treatment efficacy and interpreting available literature in which multiple scoring systems are reported. Given the critical importance of physical examination, we compared 3 scoring systems to clarify statistical relationships between current validated evaluation methods. METHODS: The medical records of children with BPBP treated at a single institution over a 14-year period were retrospectively reviewed. Modified Mallet, AMS, and Toronto scores were recorded throughout the entire period. Data were included if at least 2 complete scoring systems were documented during the same examination session. Spearman correlation coefficients were calculated for all composite and subscore combinations. A concordance table was constructed for select variables found to be highly correlated. RESULTS: Total single-session score combinations were as follows: 157 Mallet and AMS, 325 AMS and Toronto, and 143 Mallet and Toronto. Composite AMS and Toronto scores were found to have a strong correlation (r=0.928, P<0.001). A concordance table comparing these variables revealed that a Toronto score of 3.5 is concordant to an AMS score of 45. Modified Mallet scores had only a moderate correlation with composite AMS (r=0.512, P<0.001) and Toronto (r=0.458, P<0.001) scores. Specifically regarding the modified Mallet score, maneuvers requiring external rotation had stronger correlations with the composite modified Mallet score than maneuvers highlighting internal rotation. CONCLUSIONS: Modified Mallet scores do not correlate well with AMS or Toronto scores and should be utilized separately when managing children with BPBP. Similarly, AMS and Toronto scores are inadequate to guide clinical decisions for which the literature cites Mallet scores as outcome measures, and vice versa. Lastly, Mallet scores should incorporate an isolated internal rotation component to adequately assess midline function. LEVEL OF EVIDENCE: Diagnostic level III.
Asunto(s)
Traumatismos del Nacimiento/clasificación , Neuropatías del Plexo Braquial/clasificación , Plexo Braquial/lesiones , Traumatismos del Nacimiento/fisiopatología , Neuropatías del Plexo Braquial/fisiopatología , Niño , Preescolar , Femenino , Humanos , Masculino , Examen Físico/métodos , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the association between gender and birth trauma in full-term infants. METHODS: A retrospective, cohort, case-control study was conducted. All singleton full-term neonates born in 1986-2009 and diagnosed with birth trauma (ICD9-CM codes 767.0-767.9) were identified from the hospital's computerized birth-discharge records. The study group was matched in a 2:1 ration with neonates delivered immediately after each index case of neonatal trauma. RESULTS: Of the 118, 280 singleton full-term infants delivered during the study period, 2876 (24/1000) experienced birth trauma. The most frequent birth traumas were scalp injury (63.9%) and clavicle fracture (32.1%). The overall risk of birth trauma was unrelated to fetal gender. However, fetal male gender was a significant and independent risk factor for scalp injury (OR=1.31, 95%-CI 1.15-1.49), and female fetal gender was a significant and independent risk factor for clavicle fracture (OR=1.27, 95%-CI 1.09-1.49). The significance of these associations persisted even after adjustment for potential confounders including mode of delivery, gestational age, neonatal length, timing of delivery, head circumference, parity, and birth weight. CONCLUSION: Fetal gender appears to be a predisposing risk factor for specific types of birth trauma. Further studies are needed to investigate the reasons for this observation.
Asunto(s)
Traumatismos del Nacimiento/epidemiología , Traumatismos del Nacimiento/etiología , Caracteres Sexuales , Nacimiento a Término , Adulto , Traumatismos del Nacimiento/clasificación , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Masculino , Parto/fisiología , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Nacimiento a Término/fisiología , Adulto JovenRESUMEN
Bone fractures in childhood are a common occurrence. A differentiated assessment of fractures is of great importance for the diagnostics, therapy planning and estimation of the prognosis. This review article explains the most important characteristics of skeletal trauma in childhood. Skeletal development, the mechanisms of fracture healing and growth disorders after injury to the epiphyseal plates and classification of fractures will be discussed and typical bone fractures in children and the pitfalls in X-ray diagnostics are demonstrated.
Asunto(s)
Desarrollo Óseo/fisiología , Epífisis Desprendida/diagnóstico por imagen , Curación de Fractura/fisiología , Fracturas Óseas/diagnóstico por imagen , Trastornos del Crecimiento/etiología , Fracturas de Salter-Harris , Adolescente , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/diagnóstico por imagen , Traumatismos del Nacimiento/fisiopatología , Traumatismos del Nacimiento/terapia , Niño , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/legislación & jurisprudencia , Preescolar , Diagnóstico Diferencial , Errores Diagnósticos , Epífisis Desprendida/clasificación , Epífisis Desprendida/fisiopatología , Epífisis Desprendida/terapia , Testimonio de Experto/legislación & jurisprudencia , Femenino , Fracturas Óseas/clasificación , Fracturas Óseas/fisiopatología , Fracturas Óseas/terapia , Trastornos del Crecimiento/diagnóstico por imagen , Trastornos del Crecimiento/fisiopatología , Placa de Crecimiento/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Mala Praxis/legislación & jurisprudencia , Pronóstico , RadiografíaRESUMEN
Brachial plexus injuries have a steady occurrence in the pediatric population from a variety of sources. The various approaches taken to diagnosing and treating this injury have long been fraught with controversy. This has been compounded with advances in medical technology and surgical techniques. Our paper attempts to give a short discussion of the epidemiology of brachial plexus injuries and delineate the specific controversies that exist in diagnosis and treatment.
Asunto(s)
Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/terapia , Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/terapia , Plexo Braquial/lesiones , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/epidemiología , Neuropatías del Plexo Braquial/clasificación , Neuropatías del Plexo Braquial/epidemiología , Diagnóstico Diferencial , Humanos , Recién Nacido , Grupo de Atención al PacienteRESUMEN
A classification system of various forms of major newborn birth injuries is clearly lacking in the literature. Currently, no scales exist for distinguishing degrees, extent, or distinctions of major birth injuries. The purpose of this study was to use published and online literature to explore the timing, prediction, and outcomes of major newborn birth injuries. Potential antecedents and causes were used in depicting what were reported to be major birth injuries. The outcome of this literature search was the development of a classification table synthesizing the most frequently reported (n = 20) major newborn birth injuries. This classification was developed according to (1) types of tissue involved in the primary injury, (2) how and when the injury occurred, and (3) the relationship of the injury to birth outcomes. A classification scheme is critically needed as the first step to achieving preventive interventions and plans for long-term recovery from birth injuries. Because major birth trauma contributes to increased neonatal morbidity and mortality, its occurrence requires careful study and preventive efforts to better promote newborn health.
Asunto(s)
Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/epidemiología , Traumatismos del Nacimiento/etiología , Traumatismos del Nacimiento/prevención & control , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Parto Obstétrico/enfermería , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Puntaje de Gravedad del Traumatismo , Morbilidad , Evaluación en Enfermería , Enfermería Obstétrica , Forceps Obstétrico/efectos adversos , Evaluación de Resultado en la Atención de Salud , Vigilancia de la Población , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo/epidemiología , Prevención Primaria , Factores de RiesgoAsunto(s)
Parálisis Cerebral/clasificación , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/epidemiología , Causalidad , Parálisis Cerebral/diagnóstico , Parálisis Cerebral/epidemiología , Niño , Diagnóstico Diferencial , Humanos , Recién Nacido , Enfermedades del Prematuro/clasificación , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/epidemiología , Limitación de la Movilidad , Examen Neurológico , Terminología como AsuntoRESUMEN
INTRODUCTION: This work focuses on the usefulness of assessment based on seven body positions according to Vojta for early detection of developmental abnormalities of the central nervous system. As additional factors, Apgar score at 1st and 5th minute of life, as well as asymmetry of head or of whole body at the time of investigation (usually third month of life) were analyzed in correlation with subsequent diagnosis of cerebral palsy usually established after the first year of life. MATERIAL AND METHODS: The study group consisted of 57 children with birthweight lower than 1500 grams. Seven children were diagnosed with cerebral palsy at the age of one year. RESULTS: The following conclusions were drawn: Vojta's diagnostic method is very sensitive in detecting injury of the central nervous system early in life; high correlation was found between cerebral palsy and asymmetry of the body, but not of the head; low Apgar score at 5th but not at 1st minute is highly predictive for progression to cerebral palsy in infants with very low birthweight.
Asunto(s)
Puntaje de Apgar , Lesiones Encefálicas/diagnóstico , Discapacidades del Desarrollo/diagnóstico , Enfermedades del Recién Nacido/diagnóstico , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Equilibrio Postural , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/diagnóstico , Lesiones Encefálicas/clasificación , Parálisis Cerebral/diagnóstico , Parálisis Cerebral/epidemiología , Parálisis Cerebral/rehabilitación , Niño , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/rehabilitación , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Enfermedades del Recién Nacido/rehabilitación , Tamizaje Neonatal/métodos , Valor Predictivo de las PruebasRESUMEN
Upper-arm weakness (paresis) or paralysis indicates peripheral-nerve damage to the brachial plexus, a network of lower cervical and upper thoracic spinal nerves supplying the arm, forearm, and hand. Physical findings reflect muscle paralysis from spinal nerve roots. The mechanism of injury includes maternal, obstetric, and infant factors that apply traction on or compression to the anatomically vulnerable brachial plexus. Nerve regeneration can occur if nerve tissue components are preserved. Recovery is affected by multiple factors, including the type and site of injury, intervention timing, and developmental factors. The majority of injuries recover in days or months; however, residual deficits can persist. Part 1 of 2 of this article provides an overview of the neurophysiology of peripheral-nerve damage and nerve regeneration. The multifactorial etiology of brachial plexus injuries will be reviewed. Photographs and on-line video clips will enhance the description of the brachial plexus injury classifications and illustrate mechanisms of shoulder dystocia and obstetric relief maneuvers. A systematic approach to the physical examination will be explored in Part 2. Serial evaluation of motor function recovery is essential and is accomplished by appropriate referrals and follow-up. Part 2 will also describe treatment options and discuss anticipatory parent guidance.
Asunto(s)
Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/fisiopatología , Plexo Braquial/lesiones , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/enfermería , Plexo Braquial/fisiopatología , Femenino , Humanos , Recién Nacido , Enfermería Neonatal/métodos , Embarazo , Factores de RiesgoRESUMEN
The use of the term "obstetrical complications" (OCs) and its variations to encompass diverse physiological mechanisms (e.g., genetic, ischemic, hemorrhagic, infectious) of disruption to fetal/neonatal brain development has engendered inconsistency, confusion, and controversy. The principal reason is that the term OCs belies the absence of a fully adequate conceptual framework for characterizing neurodevelopmental risk. We propose that neurodevelopmental risk factors for schizophrenia can be assessed more clearly if broad OC scales are replaced by measures representing more homogeneous pathways of disturbed brain development. Using a new OC classification, we found that disordered growth related to hypoxic-ischemic compromise to early brain development may confer an elevated risk of schizophrenia and other adult-onset psychoses, particularly in the presence of familial risk. Abnormal fetal and neonatal brain growth and development in schizophrenia and OCs may also, at least in part, result from genetic factors and could help explain the relation between seemingly inconsistent OCs identified in prior research.
Asunto(s)
Traumatismos del Nacimiento/clasificación , Encéfalo/crecimiento & desarrollo , Complicaciones del Embarazo/clasificación , Esquizofrenia/etiología , Encéfalo/patología , Desarrollo Embrionario y Fetal , Femenino , Humanos , Embarazo , Medición de Riesgo , Esquizofrenia/epidemiología , Esquizofrenia/genéticaRESUMEN
Obstetric brachial plexus palsy has two distinct categories: (1) early obstetric brachial plexus palsy (or obstetric brachial plexus palsy in an infant) and (2) late obstetric brachial plexus palsy with deformity (or obstetric brachial plexus palsy in a child). Both early and late obstetric brachial plexus palsy lack a uniform evaluation system, and this makes correlation between them difficult. Clinical evaluation of obstetric brachial plexus palsy in infants is difficult, but in children it is easier. Here, we utilized a new evaluation system, called "Score of 10," to evaluate 121 late obstetric brachial plexus palsy patients based on patient's functional ability and surgeon's feasibility for reconstruction. "Score of 10" is a method combining the Erb and Klumpke scores. The Erb score gives points for upper plexus functions including shoulder abduction, shoulder external rotation, elbow flexion, elbow extension, forearm supination, forearm pronation, and trumpet sign. The Klumpke score gives points for lower plexus functions including wrist extension, wrist flexion, metacarpophalangeal joint extension, interphalangeal joint extension, finger flexion, thumb adduction, and thumb abduction. The aims of this evaluation system are to determine the relationships between early and late obstetric brachial plexus palsy, to predict the progressive changes that take place with aging, and to propose the possible operation procedures to reconstruct. However, this evaluation system may differ by time and may not be suitable for comparisons between pre- and postreconstruction.
Asunto(s)
Traumatismos del Nacimiento/fisiopatología , Plexo Braquial/lesiones , Parálisis/fisiopatología , Adolescente , Adulto , Envejecimiento/fisiología , Traumatismos del Nacimiento/clasificación , Traumatismos del Nacimiento/cirugía , Niño , Preescolar , Articulación del Codo/fisiopatología , Estudios de Evaluación como Asunto , Estudios de Factibilidad , Femenino , Dedos/fisiopatología , Estudios de Seguimiento , Antebrazo/fisiopatología , Predicción , Humanos , Masculino , Articulación Metacarpofalángica/fisiopatología , Contracción Muscular/fisiología , Parálisis/clasificación , Parálisis/cirugía , Pronación , Procedimientos de Cirugía Plástica , Rotación , Articulación del Hombro/fisiopatología , Supinación , Pulgar/fisiopatología , Articulación de la Muñeca/fisiopatologíaRESUMEN
OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.
Asunto(s)
Puntaje de Apgar , Asfixia Neonatal/diagnóstico , Traumatismos del Nacimiento/diagnóstico , Lesiones Encefálicas/diagnóstico , Tamizaje Neonatal/métodos , Asfixia Neonatal/clasificación , Sesgo , Traumatismos del Nacimiento/clasificación , Lesiones Encefálicas/clasificación , Humanos , Recién Nacido , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
The classification of miscellaneous clinical features in obstetric palsies is difficult due to variations during growth, regeneration, plexus repair and secondary surgery. Any useful comparison of different forms of therapy requires universally recognised norms of evaluation. Several proposals have already found clinical application. Their employment will help to unify the results of our evaluation.
Asunto(s)
Brazo/inervación , Traumatismos del Nacimiento/clasificación , Plexo Braquial/lesiones , Parálisis/clasificación , Traumatismos del Nacimiento/cirugía , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Microcirugia , Regeneración Nerviosa/fisiología , Parálisis/cirugía , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/diagnóstico , Reoperación , Transferencia Tendinosa/métodosRESUMEN
Evaluación prospectiva de una cohorte de recién nacidos, para determinar la incidencia de Traumatismo Obstétrico (TO), la clasificación en sus diferentes tipos, y los factores asociados a la ocurrencia de TO, definido éste como toda lesión producto de fuerzas que intervengan en el periodo comprendido entre el inicio del trabajo de parto y el pinzamiento del cordón umbilical. De agosto 1987 a julio de 1990 (tres años) se diagnosticó TO en 39 de 1155 recién nacidos vivos, lo que da una incidencia de 3.4 por ciento o 33.8 por 1000 nacidos vivos. El TO más frecuente fue cefalohematoma (25/39), seguido de fractura de clavícula (8/39), equimiosis de tejidos blandos (4/39), hematoma de tejidos blandos (2/39), heridas (2/39), lesión de plexo braquial (1/39) y hematoma subgaleal (1/39). Se encontró asociación significativa de la ocurrencia de TO con peso para la edad gestacional: nacimiento vía vaginal;aplicación de fórceps, sobre todo medios, y con el uso de inductoconducción.