Common Health Problems of the Neonate

Birth injuries are bodily injuries sustained by the newborn during the birthing process. They are more likely to occur if there’s uterine dysfunction, like with prolonged labor or precipitous labor, which is labor that lasts less than three hours, resulting in a rapid delivery.

Common risk factors for birth injuries are when the baby is large for gestational age; when there’s cephalopelvic disproportion, meaning that the presenting part is too large to fit through the mother’s pelvis; when the fetal body is misaligned, like with a breech or brow presentation; when there’s shoulder dystocia, which can happen when one of the baby’s shoulders get stuck during delivery; or during a forceps or a vacuum-assisted delivery.

The most common kind of birth injuries are soft tissue injuries, which typically occur as a result of excessive pressure as the fetus is pressed against the maternal pelvis. With sustained pressure, petechiae and bruising can often be seen on the baby’s head, neck, and face. Also, small blood vessels in the sclera can break, causing subconjunctival hemorrhages which look like red spots on the whites of the eyes. Lastly, when instruments, like forceps, are used, bruises and abrasions may appear on the sides of the face in the same shape as the instrument. Similarly, when a vacuum extractor is used, a clearly marked circle of petechiae, bruises, or abrasions can be seen on the occiput.

Injuries can also occur when there’s trauma to the nerves during the birth process. Injury to the brachial plexus, which is a network of nerves responsible for carrying sensory and motor signals to the upper limbs, is one of the most common types of birth-related nerve injuries. This can happen when the position of the baby’s arm, shoulder, or neck are altered, so that stretching, pulling, or tearing of the brachial plexus occurs.

When the upper plexus is damaged, it's known as Erb palsy, and the resulting paralysis causes the affected arm to hang limply with the shoulder and arm adducted and internally rotated, elbow extended, forearm pronated, and wrist and fingers flexed. When the lower plexus is damaged, it's called Klumpke palsy, resulting in supination of the forearm, extension of the wrist, and flexion of the fingers on a limp hand. In all forms of brachial plexus injury, the Moro, or startle, reflex is absent on the affected side. Sometimes, damage to cranial nerve VII, or the facial nerve, can result in a unilateral facial nerve paralysis, which is easiest to observe when the baby cries. Typically, on the affected side, there’s an inability to completely close the eye, the eyebrow may sag, and the mouth often droops. The condition resolves spontaneously within a few days or several weeks.