Skull Fractures and Birth Trauma

Objective: In an attempt to further define the spectrum of cranial birth injuries, we analyzed 21 consecutive cranial birth injuries seen at our institution. Methods: We performed a retrospective chart review from the medical records of our department from 1994 to 2015. We included 21 infants of 36 weeks gestational age or older with a diagnosis of cranial birth injury (severe cephalhematoma, skull fracture including growing fracture, epidural, subarachnoid and subdural hemorrhage, intracerebral and intraventricular hemorrhage and other types of brain injury). Types of injuries and their locations, presenting signs and symptoms and their timing, and what treatment(s), if any, were required, were recorded. Various maternal and neonatal factors (apgar scores at 1 and 5 minutes, gestational age, birth weight, birth length, head circumference and parity) and the mode of delivery (spontaneous vaginal delivery, elective C-section, urgent C-section, use of forceps or vacuum extraction) were recorded. Results: The most common initial presentations were swelling of the skull (43% of cases) and seizures (19% of cases). Average Apgar scores were 6.45 at 1 min and 8.4 at 5 min; 48% of children had abnormally low Apgar scores at 1 min. The most common intracranial lesion were skull fractures (33%). Neurosurgical treatment was required in 11 infants (52%). One infant in our series died. Assisted mechanical delivery by either forceps and/or vacuum extraction occurred in 43% of infants. In comparison, in the year 2013 only 13.97% of deliveries at our institution were mechanically assisted. Conclusion: Although this series is too small tomake firm conclusions, it is remarkable that the rates of assisted mechanical deliveries in our series far exceeded the rates at our institution in the year 2013. Publication Type: Journal: Conference Abstract