Difficult birth is the main contributor to birth‐related fracture and accidents to other neonatal fractures

Högberg, Ulf; Fellman, Vineta; Thiblin, Ingemar; Karlsson, Ruth; Wester, Knut

doi:10.1111/apa.15217

Cited by 21 publications

(38 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rib fractures may occur during birth [7]. We have previously shown that rib fractures diagnosed among neonates have an association with difficult birth [10]; the register case-control study supports this, as the controls were more often delivered by vacuum extraction and there was a higher proportion of big babies among controls. It is possible that there were birth-related rib fractures in the case-series, but this could not be ascertained.…”

Section: Discussionmentioning

confidence: 79%

“…The possible non-accidental trauma mechanism causing rib fractures has not been fully established [8], but the most common theory is thoracic compression when the infant is violently shaken [2]. Rib fractures, including multiple fractures, are rarely reported in association with birth, only in one case-series [9] and one population register study [10]. In both studies, the infants had concomitant clavicle fractures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rib fractures in infancy, case-series and register case-control study from Sweden

Högberg

Thiblin

2021

Journal of Pediatric Endocrinology and Metabolism

Self Cite

View full text Add to dashboard Cite

Objectives To assess cases with rib fractures in infants under observation for or with an abuse diagnosis, and to compare risk factors with that in infants with fractures but no abuse diagnosis. Methods Design was case-series and register case-control of infants (aged <1 year) with rib fractures. Data was clinical records for the case-series (n = 26) and from national health registers for the case-controls (n = 28 and n = 31). Outcome measures were maternal and perinatal characteristics, reasons for appointment, examination, diagnoses, blood tests, and radiologic findings. Results The case-series had a median age of 70 days. A majority were detected through a skeletal survey for abuse investigation. Sixteen were boys, three were preterm and six were small-for-gestational age. Three carers had noticed popping sound from the chest; no infants showed signs of pain at physical examination. Mean number of fractures was 4.2, and 24 had callus. Bone mineralisation was scarcely reported. Metabolic panel was not uniformly analysed. The register case-control had a median age of 76 days, sharing risk factors such as maternal overweight/obesity, male sex, prematurity, and being small-for-gestational age. Cases more often had subdural haemorrhage, retinal haemorrhage, or long-bone fractures, controls more often had neonatal morbidity, respiratory infection, or a fall accident. Detection of fracture at time of a major surgery (n = 6) and rickets/vitamin D deficiency (n = 5) appeared in both groups, but was delayed among the cases. Conclusions Rib fractures in young infants, diagnosed as abuse, are usually asymptomatic and healing. A substantial proportion had metabolic risk factors, suggesting false positive cases.

show abstract

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Rib fractures in infancy, case-series and register case-control study from Sweden

Högberg

Thiblin

2021

Journal of Pediatric Endocrinology and Metabolism

Self Cite

View full text Add to dashboard Cite

show abstract

“…Diagnosies of birth-related fractures might be delayed for femur fractures, [1,14] especially among the preterm-born, [15] and for humerus shaft fractures [3,8,11]. We have previously reported that some birth-related fractures of femur or other long bones are diagnosed after the rst week of life and in some cases at even higher age [6]. Our ndings show an overlap between birth-related femur fractures and other long bone fractures.…”

Section: Discussionmentioning

confidence: 63%

“…Our cases shared perinatal risk factors con rming the state of knowledge. For femur shaft fracture, these factors were breech presentation [1,2,6], multiple birth, and prematurity [1,6], and for humerus shaft fractures, they were vacuum-assisted delivery, shoulder dystocia, and heavy birth weight, as reported for other birth-related long bone fractures [6]. A high proportion of cesarean delivery in connection with shaft fractures [1][2][3] was not evident from our ndings.…”

Section: Discussionmentioning

confidence: 63%

The Epidemiology of Infant Shaft Fractures of Femur or Humerus by Incidence, Birth, Accidents, and Other Causes

Iversen

Thiblin

Högberg

2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Knowledge of femur and humerus shaft fractures during infancy is scarce. The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and those diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.Methods: Children born in 1997–2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma, abuse, or bone fragility disorders. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population. Results: The incidence for birth-related femur shaft fractures was 0.024‰ (n=45) and that for birth-related humerus shaft fractures was 0.101‰ (n=188). The incidence was 0.154‰ for later femur shaft fractures (n=287) and 0.073‰ for later humerus shaft fractures (n=142). Birth-related femur shaft fracture was associated with preterm, multiple birth, breech, cesarean, and small-for-gestational age, while humerus shaft fracture was associated with preterm, multiple birth, birth weight > 4,000 g, and shoulder dystocia. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with both fracture types, especially among those aged < 6 months, where approximately 20% and 14% of cases, respectively, were associated with abuse. Fall accidents were reported in 73% and 56% among those with later femur and humerus shaft fractures, respectively. Conclusion: This study provides data on epidemiology, birth, parental characteristics, and reported accidents in relation to femur and humerus shaft fractures during infancy. Few children had a bone fragility diagnosis. Fall accidents were the main contributor to femur or humerus shaft fracture during infancy; however, the proportion of fractures attributed to maltreatment was high in children under 6 months.

show abstract

“…However, although it is rare, skull fracture could occur at birth if there are difficulties during delivery. The overall fracture incidence was 2–3.7 per 100000 live births [ 12 , 17 ]. Some insists on that this data is underestimated because of undetected clinically silent simple linear fractures [ 3 , 17 , 25 ].…”

Section: Skull Fracturesmentioning

confidence: 99%

Head Injury during Childbirth

Chong

2022

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Head injuries are the most common type of birth injuries. Among them, most of the injuries is limited to the scalp. and the prognosis is good enough to be unnoticed in some cases. Intracranial injuries caused by excessive forces during delivery are rare. However, since some of them can be fatal, it is necessary to suspect it at an early stage and evaluate thoroughly if there are abnormal findings in the patient.

show abstract

Difficult birth is the main contributor to birth‐related fracture and accidents to other neonatal fractures

Cited by 21 publications

References 24 publications

Rib fractures in infancy, case-series and register case-control study from Sweden

Rib fractures in infancy, case-series and register case-control study from Sweden

The Epidemiology of Infant Shaft Fractures of Femur or Humerus by Incidence, Birth, Accidents, and Other Causes

Head Injury during Childbirth

Contact Info

Product

Resources

About