Diseases & Conditions


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Birth Injury


Birth injury is damage sustained during the birthing process, usually occurring during transit through the birth canal.

A difficult delivery, with the risk of injury to the fetus, may occur if the birth canal is too small or the fetus is too large (as sometimes occurs when the mother has diabetes). Injury is also more likely if the fetus is lying in an abnormal position before birth. Overall, the rate of birth injuries is much lower now than in previous decades.

Many newborns experience minor injuries from the birthing process, with swelling or bruising only in certain areas.

Head Injury: In most births, the head is the first part to enter the birth canal and experiences much of the pressure during the delivery. Swelling and bruising are not serious and resolve within a few days. Cephalohematoma is a bleeding injury in which a soft lump forms over the surface of one of the skull bones but below its thick fibrous covering. A cephalohematoma does not need treatment and disappears over weeks to months.

Very rarely, one of the bones of the skull may fracture. Unless the fracture forms an indentation (depressed fracture), it heals rapidly without treatment.

Nerve Injury: Rarely, nerve injuries may occur. Pressure to the facial nerves caused by forceps can result in weakness of the muscles on one side of the face. This injury is evident when the newborn cries and the face appears asymmetric. No treatment is needed, and the newborn usually recovers within a few weeks.

In a difficult delivery of a large infant, some of the larger nerves to one or both of the newborn's arms can be stretched and injured. Weakness (paralysis) of the newborn's arm or hand results. Occasionally, the nerve going to the diaphragm (the muscle that separates the organs of the chest from those of the abdomen) is damaged, resulting in paralysis of the diaphragm on the same side. In this case, the newborn may have difficulty breathing. Injury of the nerves to the newborn's arm and diaphragm usually resolves completely within a few weeks. Extreme movements at the shoulder should be avoided to allow the nerves to heal. Very rarely, the arm and possibly the diaphragm remain weak after several months. In this case, surgery may be needed to reattach torn nerves.

Injuries to the spinal cord due to overstretching during delivery are extremely rare. These injuries can result in paralysis below where the injury occurred. Damage to the spinal cord is often permanent.

Bone Injury: Rarely, bones may be broken (fractured) during a difficult delivery. A fracture of the collarbone is most common. Fractures of bones in the newborn are splinted and almost always heal completely and rapidly.

Common Birthmarks and Minor Skin Conditions in the Newborn

There are a number of skin conditions that are considered normal in the newborn. There may be bruises or marks from forceps on the newborn's face and scalp, or bruising of the feet following a breech delivery, all of which resolve within just a few days. Pink marks that are due to dilated capillaries under the skin may be seen on the forehead just above the nose, in the upper eyelids, or at the back of the neck (where it is called “stork-bite”). This type of birthmark fades as the infant grows but in some people remains as a faint mark that becomes brighter when the person becomes excited or upset. Some newborns have a few acne pimples, especially over the cheeks and forehead. These go away, and the only recommended action is to keep the skin clean and not to use creams or lotions.

Milia are tiny, pearly white cysts that are normally found over the nose and upper cheeks. Milia become smaller or disappear over a period of weeks. Similar white cysts are sometimes found on the gums or in the midline of the roof of the mouth (Epstein's pearls) and are also of no consequence.

Mongolian spots are bluish gray, flat areas that usually occur over the lower back or buttocks. At first glance they appear to be bruises but are not. They are usually seen in black or Asian newborns and are of no consequence.

A “strawberry hemangioma” is a common birthmark. It is a flat, slightly pink or red area anywhere on the skin. Over a period of weeks, it becomes darker red and also becomes raised up over the surface of the skin, appearing much as a strawberry. After several years, strawberry hemangiomas shrink and become fainter, so that by the time the child reaches school age, most are no longer visible. For this reason, surgery is not needed.

Last full review/revision February 2003

Source: The Merck Manual Home Edition