A Clinical Atlas of Chinese Infants

Section 3. Trauma (Photos 41-52)

SECTION3 1 TRAUMA (photos 41-52) 41 42 .. 4J Bleeding scalp wound. This baby had foetal blood sampling taken on the scalp during early labour to monitor for foetal distress. The bleeding from the tiny puncture site had persisted leading to significant blood loss. An urgent blood transfusion was given after delivery. 42 Facial palsy, R. This picture shows facial asymmetry and inability to dose the R eye when the baby cries. Unilateral facial palsy is a fairly common complication after forceps delivery. The compression effect of the forceps on the branch of the facial nerve is often transient, and total recovery is usually anticipated. 43 44 43, 44 Erb's palsy. This picture shows the typical position of the arm wilh Erh's palsy in the baby who has gone through a difficult breech delivery (43). This resulted from vigorous stretching of the upper brachia1 plexus (~ to C5 ) in the manipulation. The palsy resolved after one week, but the ipsilateral paralysis of the R hemidiaphragm showed no change even after three months (44). 45 46 45. 46 Complications of vacuum extraction. This baby had a difficult vaginal delivery and vacuum extraction had been applied three times. Skull X-ray film taken immediately aftcrdclivcry (45) demonstrated marked elevation of the parietal bones. A repeat xfay film taken 8 days latershowed thai the skull was almost normal in appearance (46). The baby remained asymptomatic. 47 48 47 Cephalhaematoma. This picture shows a large swelling over the R parietal hone which became obvious on day 3 in this baby who was delivered vaginally. Cephalhaematoma is caused by the accumulation of blood from the ruptured small vessels in the subperiosteal region, and is not to be confused with caput succedaneum. A large cephalhaematoma can give rise to anaemia and it aggravates jaundice . 48 Subaponeurotic haemorrhage. This newborn baby was delivered by vacuum extraction, and he was later found to develop extensive swelling and discoloration behind the R ear due to subaponeurotic haemorrhage. This is an uncommon complication of vacuum extraction and blood loss can be marked; significant hyperbilirubinaemia often follows. Causes for ble.!ding tcndcncy in the newborn need to be excluded in the investigation. 49 50 49 Skull fracture. This newborn baby was accidentally dropped on the floor and X-ray skull film revealed a linear fracture in the R parietal bone. The baby remained well and was discharged home after 3 days. 50 Pneumothorax. The baby was in serious respiratory distress and X-ray chest film showed Rtension pneumothorax, med iastinal shift, and collapse of L lung. Pneumothorax can occur spontaneously, or as a complication of hyaline membrane disease, especially common following mecon ium aspiration. In this infant w ith tension pneumothorax , rapid insertion of either a chest drain or a 19-9auge nced leintracath is a life saving measure. 31 52 51. 52 Bruising and tissue necrosis due to iatrogenic cause.The bruise over the baby's forehead (51) is the extravasated sile of sodium bicarbonate which has been infused into the scalp vein. Tissue necrosis, and laterscarring, may follow (52) if fluid contains irritants such as calcium g]uconate, hypertonic glucose solution, or solutions used in hyperalimentation. II ...