Birth trauma in the head and neck

C. Anthony Hughes, Earl H. Harley, Gregory Milmoe, Rupa Bala, Andrew Martorella

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objectives: To review the medical records of neonates found to have birth-associated trauma of the head and neck region. To describe the anomalies, physical findings, and possible sequelae of these injuries and to bring attention to the cause of mechanical birth injury as a potential cause of anomalies in the infant. Design: Case-controlled retrospective chart review of a cohort of patients identified with birth-associated trauma to the head and neck from January 1,1991, to March 1,1997. Setting: Academic tertiary care medical center. Patients: Medical records from infants born or transferred with the diagnosis of birth trauma were reviewed. Medical records from a control group of 148 uninjured full-term infants born during the same period were reviewed for comparison. Neonatal charts, including labor and delivery records, were analyzed. Main Outcome Measures: Each patient record was reviewed for diagnosis, associated injuries, maternal statistics, gestational age, birth weight and size, Apgar scores, type of delivery, length of labor, complications of labor, and length of hospital stay. Results: One hundred sixty-four infants (incidence, 0.82%; prevalence, 9.5 per 1000 live-births) were identified with 175 birth-associated injuries to the head and neck. The most common finding was cephalhematoma (56.6%). Other findings included scalp and/or facial lacerations (12%) and hematomas (2.3%), facial nerve paresis (8.6%), brachial plexus injuries (5.1%), clavicular (9.1%) and skull fracture (2.9%), nasal septal dislocation (0.6%), and phrenic (1.7%) and laryngeal nerve injuries (0.6%). Risk factors included birth weight (P = .001) vaginal delivery (P = .001), primiparity (P = .02), forceps delivery (P = .005), vacuum delivery (P = .001), infants categorized as large for gestational age (P = .02), and male infant sex (P = .03). Apgar scores were also noted to be lower in our study population (P = .001). Risk factors for specific types of injuries varied. However, facial nerve paralysis was associated with multiple birth injuries (P = .001), and 2 of 3 phrenic nerve injuries co-occurred with brachial plexus injuries. Correlation coefficients for factors such as maternal age, gravidity, and race were low. Conclusion: Birth-associated head and neck trauma is rare. However, mechanical birth-associated trauma must be considered when assessing anomalies, injuries, respiratory difficulty, or feeding difficulties in the neonate or infant. A comprehensive approach is required to diagnose and manage these patients.

Original languageEnglish (US)
Pages (from-to)193-199
Number of pages7
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume125
Issue number2
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Craniocerebral Trauma
Neck
Parturition
Birth Injuries
Wounds and Injuries
Arm Injuries
Medical Records
Phrenic Nerve
Apgar Score
Brachial Plexus
Facial Paralysis
Facial Nerve
Birth Weight
Gestational Age
Laryngeal Nerve Injuries
Length of Stay
Obstetric Labor Complications
Newborn Infant
Gravidity
Multiple Birth Offspring

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Birth trauma in the head and neck. / Hughes, C. Anthony; Harley, Earl H.; Milmoe, Gregory; Bala, Rupa; Martorella, Andrew.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 125, No. 2, 01.01.1999, p. 193-199.

Research output: Contribution to journalArticle

Hughes, CA, Harley, EH, Milmoe, G, Bala, R & Martorella, A 1999, 'Birth trauma in the head and neck', Archives of Otolaryngology - Head and Neck Surgery, vol. 125, no. 2, pp. 193-199. https://doi.org/10.1001/archotol.125.2.193
Hughes, C. Anthony ; Harley, Earl H. ; Milmoe, Gregory ; Bala, Rupa ; Martorella, Andrew. / Birth trauma in the head and neck. In: Archives of Otolaryngology - Head and Neck Surgery. 1999 ; Vol. 125, No. 2. pp. 193-199.
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abstract = "Objectives: To review the medical records of neonates found to have birth-associated trauma of the head and neck region. To describe the anomalies, physical findings, and possible sequelae of these injuries and to bring attention to the cause of mechanical birth injury as a potential cause of anomalies in the infant. Design: Case-controlled retrospective chart review of a cohort of patients identified with birth-associated trauma to the head and neck from January 1,1991, to March 1,1997. Setting: Academic tertiary care medical center. Patients: Medical records from infants born or transferred with the diagnosis of birth trauma were reviewed. Medical records from a control group of 148 uninjured full-term infants born during the same period were reviewed for comparison. Neonatal charts, including labor and delivery records, were analyzed. Main Outcome Measures: Each patient record was reviewed for diagnosis, associated injuries, maternal statistics, gestational age, birth weight and size, Apgar scores, type of delivery, length of labor, complications of labor, and length of hospital stay. Results: One hundred sixty-four infants (incidence, 0.82{\%}; prevalence, 9.5 per 1000 live-births) were identified with 175 birth-associated injuries to the head and neck. The most common finding was cephalhematoma (56.6{\%}). Other findings included scalp and/or facial lacerations (12{\%}) and hematomas (2.3{\%}), facial nerve paresis (8.6{\%}), brachial plexus injuries (5.1{\%}), clavicular (9.1{\%}) and skull fracture (2.9{\%}), nasal septal dislocation (0.6{\%}), and phrenic (1.7{\%}) and laryngeal nerve injuries (0.6{\%}). Risk factors included birth weight (P = .001) vaginal delivery (P = .001), primiparity (P = .02), forceps delivery (P = .005), vacuum delivery (P = .001), infants categorized as large for gestational age (P = .02), and male infant sex (P = .03). Apgar scores were also noted to be lower in our study population (P = .001). Risk factors for specific types of injuries varied. However, facial nerve paralysis was associated with multiple birth injuries (P = .001), and 2 of 3 phrenic nerve injuries co-occurred with brachial plexus injuries. Correlation coefficients for factors such as maternal age, gravidity, and race were low. Conclusion: Birth-associated head and neck trauma is rare. However, mechanical birth-associated trauma must be considered when assessing anomalies, injuries, respiratory difficulty, or feeding difficulties in the neonate or infant. A comprehensive approach is required to diagnose and manage these patients.",
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