Birth Injury of the Cranium and Central Nervous System

Abstract

Birth injury of the scalp, skull and central nervous system (CNS) is a well-recognized complication of a difficult delivery. The rate of birth trauma has dropped precipitously and now accounts for less than 2% of neonatal deaths. Despite this dramatic decrease in birth-trauma mortality significant injuries still occur. A variety of risk factors clearly predispose certain infants to birth-related injury. Recent neuroradiology studies indicate that intracranial hemorrhage, even in asymptomatic infants, is not rare. Pathologists' (neuropathologists and forensic pathologists) appreciation of the spectrum of birth injuries and their sequelae is critical in order to be able to distinguish these from inflicted injuries and post-mortem changes.

Protracted vacuum extraction and neonatal intracranial hemorrhage among infants born at term: a nationwide case‐control study

“…Furthermore, diastasis of the occipital synchondrosis caused by heavy traction may produce intraparenchymal hemorrhages. [25][26][27] Given the low rates of serious head injuries after VE, we consider VE to be safe when practiced in accordance with the recommendations. 20,21 However, we find it plausible that protracted extractions and heavy traction forces may result in ICH, as suggested above.…”

“…interpretation is further supported by the fact that the excess risk remained after adjusting for possible confounders, including F I G U R E 3 Distribution (%) of numbers of pulls used in vacuum deliveries of newborn infants with (cases) and without ((%) of number of involuntary cup detachments during vacuum-assisted deliveries of newborn infants with (cases) and without (controls) a diagnosis of intracranial hemorrhage representing a complicated pregnancy and labor, and the indication for VE.The proposed mechanism of how VE may contribute to ICH involves the vertical stress and increased mechanical compression and distortion of the fetal skull and brain during traction 25. Furthermore, diastasis of the occipital synchondrosis caused by heavy traction may produce intraparenchymal hemorrhages [25][26][27]. Furthermore, diastasis of the occipital synchondrosis caused by heavy traction may produce intraparenchymal hemorrhages [25][26][27].…”

Non-traumatic depressed skull fracture in a neonate or ‘ping pong’ fracture

“…As a result of immature ossification, increased pressure on a neonatal skull can cause the calvarial bones to buckle inwards resembling on radiographs an indentation commonly found in ping pong balls. This has led to these types of injuries being labelled as ping pong fractures or pond fractures 11 12. The parietal bones are most commonly affected site followed by the frontal bones and very rarely in the occipital region 3…”

Parturitional Injury of the Head and Neck

“…In the immediate postnatal time period, a wide spectrum of extracranial, cranial (skull), and intracranial lesions may be encountered . Depending on the severity and type of the injury, location of the lesion, exerted mass effect on adjacent brain structures, development of primary (eg, anemia and hypovolemic shock in subgaleal hematomas), and/or secondary (eg, hyperbilirubinemia in subgaleal hematomas and secondary ischemic lesions in skull fractures with midline shift) complications and presence of complicating factors outside of the central nervous system (eg, systemic hypoxia, hypoperfusion, or sepsis), various degrees of reversible or irreversible brain injury may result.…”

“…Depending on the anatomical location, parturitional injuries may be classified in to various groups . Extracranial injuries include: a) scalp abrasions/lacerations; b) caput succedaneum; c) subgaleal hematomas; and d) cephalohematomas.…”