Prepared by : Ayda khader oct 2015

Fractures are rare, the most commonly affected bones are : clavicle, humerus, femur skull With all such fractures, a ‘crack’ may be heard during the birth.

clavicle fracture the most frequently bone injure in the neonate during birth and most often is an unpredictable unavoidable complication of normal birth. The infant may present with pseudoparalysis.

Fractures can occur with shoulder dystocia or a vaginal breech birth, or if the baby is macrosomic. The affected clavicle is usually the one that was nearest the maternal symphysis pubis. Brachial plexus and phrenic nerve injuries should be excluded in the affected baby.

Humerus Midshaft fractures can occur if with shoulder dystocia or during a vaginal breech birth the extended arm is forced down and born. Femur Midshaft fractures can occur during vaginal breech birth if the extended legs are forced down and born. bone.

 An X-ray examination can usually confirm the diagnosis.  The baby requires careful handling to avoid further pain, and mild analgesia, such as paracetamol may be required  Fractures of the clavicle require no specific treatment.  To immobilize a fractured humerus, place a pad in the axilla and firmly splint the arm with the elbow bent across the chest with a bandage, ensuring respirations are not embarrassed.  Immobilize a fractured femur using a splint and bandage  union of a fractured clavicle usually occurs in 7–10 days, while the humerus and femur take 2–3 weeks.

Skull  rare, these fractures, linear or depressed  may occur during prolonged or difficult instrumental births.  There may be no signs but an overlying cephalhaematoma, or signs of associated complications such as intracranial haemorrhage or neurological disturbances, may suggest a fracture's presence.  X-ray examination can confirm the fracture  skull fractures usually heal quickly with no sequelae

Convulsions  seizure/fit is a sign of neurological disturbance, not a disease, and is a medical emergency  convulsions present quite differently in the neonate  Abnormal, sudden or repetitive movements of any part of the body that are not controlled by repositioning or containment holds

:classify the convulsion as  Subtle convulsions found in term and pre-term babies  Focal tonic convulsions are more common in pre-term babies and there is extension or flexion of a limb, asymmetric postures of the body or neck  generalized tonic convulsions the baby sustains a rigid posture that is not usually detected on EEG.  clonic convulsions as focal or generalized more common in term babies  Myoclonic convulsions are the least common and affect term and pre-term babies

causes of neonatal convulsions Central nervous system Intracranial haemorrhage Intracerebral haemorrhage Hypoxic-ischaemic encephalopathy Kernicterus Congenital abnormalities Metabolic Acquired disorders of metabolism Hypo- and hyperglycaemia Hypo- and hypercalcaemia Hypo- and hypernatraemia Inborn errors of metabolism

Other Hypoxia Congenital infections Severe postnatally acquired infections Neonatal abstinence syndrome Hyperthermia

Immediate treatment necessitates obtaining assistance from a doctor ensuring that the baby has a clear airway and adequate ventilation Gentle oral and nasal suction may be required to remove any milk or mucus The need for intravenous access should be assessed Any necessary handling must be gentle nature of the convulsion is documented the pharmacologic control of the convulsion] (phenobarbital and phenytoin )most common drug

Parents  Trauma during birth are unexpected complications and parents may be shocked and anxious, and perhaps find themselves in a crisis situation  not all parents experience such feelings and some can adapt quickly to their baby's condition  One of the most important aspects of caring for the parents is in relation to communication  All parents are entitled to be given information about their baby's condition, treatment and care in ways that are considered best practice  The baby must be valued as a baby  involvement in their baby's care is essential and the family- centered care/partnership with parents approach