Approach to birth injury (pediatrics) Quiz: Ace Your Exams

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A newborn boy is born at 39 weeks of gestation via spontaneous vaginal delivery. Vacuum extraction is necessary. Apgars are 6 and 9. The pregnancy was complicated by diet-controlled diabetes mellitus in the mother. Temperature is 36.7°C (98°F), pulse is 152/min, respirations are 42/min, and oxygen saturation is 97% on room air. Birth weight is 4100 grams. The anterior fontanelle is open and flat. The infant is crying vigorously with eyes closed. Cardiopulmonary examination is within normal limits. The abdomen is soft and nondistended. Which of the following birth-related head injuries, if found on exam, could be diagnosed clinically without the need for imaging?

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Fluctuating boggy scalp edema with a fluid wave that crosses suture lines

Swelling over the skull with palpable crepitus

Palpable skull concavity

Palpable skull concavity with bleeding from the nose and seizure activity

Discrete area of swelling on the scalp that does not cross suture lines