BIRTH INJURIES On physical exam, a 12-hold newborn is noted to have nontender swelling of the head that does not cross the suture line.
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What is the most likely diagnosis?
Table 1-2. Common Injuries During Deliveries
Injury Specifics Outcome Skull fractures In utero from pressure against bones or forceps; linear: most common • Linear: no symptoms and no treatment needed • Depressed: elevate to prevent cortical injury Brachial palsy Etb-Duchene: C5—C6; cannot abduct shoulder; externally rotate and supinatc forearm; Klumpke: C7-03 : TI; paralyzed hand : Horner syndrome Most with full recovery (months); depends on whether nerve was injured or lacerated; RX : proper positioning and partial immobilization; massage and range of motion exercises; if no recovery in 3-6 mo, then ncuroplasty Clavicular fracture Especially with shoulder dystocia in vertex position and arm extension in breech Palpable callus within a week; Rx: with immobilization of arm and shoulder Facial nerve palsy Entire side of face with forehead; forceps delivery or in utcro pressure over facial nerve Improvement over weeks (as long as fibers were not torn); need eye care; neumplasty if no improvement (torn fibers) Caput succalanetun Diffuse edematous swelling of soft tissues of scalp; crosses suture lines Disappears in first few days; may lead to molding for weeks Cephalohematoma Subperiosteal hemorrhage: does not cross suture lines May have underlying linear fracture; resolve in 2 wk to 3 mo; may calcify; jaundice
A newborn infant at birth is noted to have acrocyanosis, a heart rate of 140, gnmaces to stimulation, and is acbve and with a lusty cry. What is her Apgar score?
Table I-I. Apgar Scoring System
Evaluation 0 Points 1 Point 2 Points Heart rate 0 <100/min >100/min Respiration None Irregular, shallow, gasps Crying Color Blue Pale, blue extremities Pink Tone None Weak, passive Active Reflex irritability None Facial grimace Active withdrawal
What You Need to Know about the Apgar Scoring System
• Apgar scores are routinely assessed at I and 5 minutes, and every 5 minutes thereafter as long as resuscitation Is continuing. • The 1-minute score gives an idea of what was going on during labor and delivery. • The 5•minute score gives en idea of response to therapy (resuscitation). • In general, the Apgar score is not predaive of outcome: however, infants with score 0-3 at 5 minutes and longer compared to infants with score 7-10 have a worse neurologc outcome.
Newborn Care • Vitamin K IM • Prophylactic eye erythromycin • Umbilical cord care • Hearing test • Newborn screening tests
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