Birth trauma in the head and neck

Objectives: To review the medical records of neonates found to have birth-a ssociated trauma of the head and neck region. To describe the anomalies, ph ysical findings, and possible sequelae of these injuries and to bring atten tion to the cause of mechanical birth injury as a potential cause of anomal ies in the infant. Design: Case-controlled retrospective chart review of a cohort of patients identified with birth-associated trauma to the head and neck from January 1 , 1991, to March 1, 1997. Setting: Academic tertiary care medical center. Patients: Medical records from infants born or transferred with the diagnos is of birth trauma were reviewed. Medical records from a control group of 1 48 uninjured full-term infants born during the same period were reviewed fo r comparison. Neonatal charts, including labor and delivery records, were a nalyzed. Main Outcome Measures: Each patient record was reviewed for diagnosis, asso ciated injuries, maternal statistics, gestational age, birth weight and siz e, Apgar scores, type of delivery, length of labor, complications of labor, and length of hospital stay. Results: One hundred sixty-four infants (incidence, 0.82%; prevalence, 9.5 per 1000 live-births) were identified with 175 birth-associated injuries to the head and neck. The most common finding was cephalhematoma (56.6%). Oth er findings included scalp and/or facial lacerations (12%) and hematomas (2 .3%), facial nerve paresis (8.6%), brachial plexus injuries (5.1%), clavicu lar (9.1%) ansi skull fracture (2.9%), nasal septal dislocation (0.6%), and phrenic (1.7%) and laryngeal nerve injuries (0.6%). Risk factors included birth weight (P = .001),vaginal delivery (P = .001),primiparity (P = .02), forceps delivery (P = .005), vacuum delivery (P = .001), infants categorize d as large for gestational age (P =.02),and male infant sex (P = .03). Apga r scores were also noted to be lower in our study population (P = .001). Ri sk factors for specific types of injuries varied. However, facial nerve par alysis was associated with multiple birth injuries (P = .001), and 2 of 3 p hrenic nerve injuries co-occurred with brachial plexus injuries. Correlatio n coefficients for factors such as maternal age, gravidity, and race were l ow. Conclusion: Birth-associated head and neck trauma is rare. However, mechani cal birth-associated trauma must be considered when assessing anomalies, in juries, respiratory difficulty, or feeding difficulties in the neonate or i nfant. A comprehensive approach is required to diagnose and manage these pa tients.