Hughes C A, Harley E H, Milmoe G, Bala R, Martorella A
Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA.
Arch Otolaryngol Head Neck Surg. 1999 Feb;125(2):193-9. doi: 10.1001/archotol.125.2.193.
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.
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.
Academic tertiary care medical center.
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.
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.
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.
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.
回顾被发现患有头颈部出生相关创伤的新生儿的病历。描述这些损伤的异常情况、体格检查结果及可能的后遗症，并提请注意机械性出生损伤作为婴儿异常潜在原因的情况。
对1991年1月1日至1997年3月1日期间被确定患有头颈部出生相关创伤的一组患者进行病例对照回顾性图表分析。
学术性三级医疗中心。
对诊断为出生创伤的出生或转诊婴儿的病历进行回顾。对同期出生的148名未受伤足月儿的对照组病历进行回顾以作比较。分析新生儿图表，包括分娩记录。
审查每份患者记录，以了解诊断、相关损伤、母亲统计数据、胎龄、出生体重和大小、阿氏评分、分娩类型、产程长度、分娩并发症及住院时间。
164名婴儿（发病率0.82%；患病率每1000例活产9.5例）被确定患有175处头颈部出生相关损伤。最常见的发现是头颅血肿（56.6%）。其他发现包括头皮和/或面部撕裂伤（12%）和血肿（2.3%）、面神经麻痹（8.6%）、臂丛神经损伤（5.1%）、锁骨骨折（9.1%）和颅骨骨折（2.9%）、鼻中隔脱位（0.6%）以及膈神经（1.7%）和喉返神经损伤（0.6%）。危险因素包括出生体重（P = 0.001）、阴道分娩（P = 0.001）、初产（P = 0.02）、产钳助产（P = 0.005）、真空助产（P = 0.001）、大于胎龄儿（P = 0.02）以及男性婴儿（P = 0.03）。在我们的研究人群中阿氏评分也较低（P = 0.001）。特定类型损伤的危险因素各不相同。然而，面神经麻痹与多处出生损伤相关（P = 0.001），3例膈神经损伤中有2例与臂丛神经损伤同时发生。母亲年龄、妊娠次数和种族等因素的相关系数较低。
出生相关的头颈部创伤很少见。然而，在评估新生儿或婴儿的异常、损伤、呼吸困难或喂养困难时，必须考虑机械性出生相关创伤。需要采用综合方法来诊断和管理这些患者。
