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Hypoxic-Ischaemic Encephalopathy (HIE)
This refers to injury to the brain, which is caused by being deprived of oxygen, due to a significant hypoxic event immediately before or during delivery
– Damage occurs immediately from primary neural death and after due to reperfusion injury
Causes:
Anything which decreases oxygen transfer across placenta or oxygenation of blood after birth
Symptoms:
– Reduced level of consciousness
– Reduced muscle tone and reflexes
– Seizures
– Inability to feed
– Respiratory distress with difficulty in maintaining adequate respiration
Tests:
– Umbilical cord blood gas analysis –> shows perinatal hypoxia
– MRI/CT –> shows neonatal encephalopathy
Management:
– Hypothermia (wrap infant in a cooling mattress)
– Aim to decrease rectal temperature to 33-34 degrees
– This reduces brain damage, reduces future disability, and improves survival rates
Soft-tissue injuries
These encompass a range of injuries that babies can experience during delivery
– They are often due to mechanical trauma caused by the scalp pushing through the cervix in a difficult delivery
– They can also occur secondary to the use of instruments in an assisted delivery.
Caput Succedaneum
This is a condition which describe the presence of a subcutaneous collection of fluid (oedema) external to the galea aponeurosis at the presenting part of the head.
– This is present immediately after or within a few hours of birth but there is no damage to the brain or the skull
Symptoms:
– Soft swelling that looks like a bump at the tip of the baby’s head
– Has indistinct margins and crosses suture lines
Management:
No treatment is needed as resolves within days
Subgaleal Haematoma
This refers to a bleed between the potential space between the galea aponeurosis and the periosteum
– Most of these cases are due to a ventouse-assisted delivery as the vacuum ruptures the small venous connections between the scalp veins and dural venous sinuses.
Symptoms:
– Fluctuant boggy swelling over the scalp (especially occipital area) which develops hours/days after delivery
– Bruising over the skin
– Can lead to haemorrhagic shock and jaundiced due to haemolysis of blood.
Management:
– Manage with ABCDE approach
– Manage haemorrhagic shock loss with fluid challenge and transfusion
– Manage jaundice with phototherapy
Cephalohematoma
This is bleeding between the periosteum and the bone, usually over parietal area
– This usually develops several hours after birth
– As the swelling is subperiosteal, it does not cross suture lines
Symptoms:
– Haematoma that forms a swelling and feels soft
– It does not cross suture lines
– If severe can develop jaundice, anaemia, or hypotension
Management:
Conservative treatment only but can up to 3 months to resolve
