Cranial birth injuries in term newborn infants

While cranial birth injuries in term infants are well recognized, to date, only small case series have been described. In an attempt to further define the spectrum of cranial birth injuries, we analyzed 41 consecutive cranial birth injuries at our institution over the period 1991-1998. The most comm on clinical presentations were apnea (39%) and seizures (37%). Average Apga r scores were 5.7 at 1 min and 7.3 at 5 min; 54% of infants had abnormally low Apgar scores at I min and 31% had abnormally low scores at 5 min. The m ost common intracranial lesion was subdural hemorrhage, present in 73% of i nfants; most had either a tentorial (57%) and/or interhemispheric (50%) loc ation. Operative treatment was required in 5 infants (12%). Two of the 41 i nfants (4.8%) died. The study group was compared with a control group of 63 randomly selected births without cranial injury. Using a stepwise logistic regression model, independently significant variables included neonatal bi rth weight, Apgar scores at 1 and 5 min and mode of delivery. Compared with the controls, the study group had a significantly higher incidence of forc eps and/or vacuum deliveries. Combining vacuum, forceps and urgent cesarean section deliveries together as 'urgent' and elective cesarean and spontane ous vaginal deliveries as 'nonurgent', we could find no significant differe nces between these two groups. Our data conflict with those of Towner et al . [N Engl J Med 1999;341:1709-1714], and suggest that the method of assiste d delivery, rather than the urgency of the delivery or dysfunctional labor per se, is a more important variable in cranial birth injuries. Copyright ( C) 2001 S. Karger AG, Basel.