CranialComplicationsinNewborns：新生兒顱內(nèi)并發(fā)癥課件

CranialComplicationsinNewbornsDavidKuykendall,MDUniversityofNevadaSchoolofMedicine2013...LayersofSkull...CephalohematomaHemorrhageofbloodvesselsbetweentheskullandperiosteumofanewbornbaby.MostcommonlythebridgingbloodvesselscrossingtheperiosteumBecausethebleedislimitedtothesubperiostealplane,thebleedislimitedtotheparticularboneofthecraniumThisdoesnotcrosssuturelines...CausesMostcommonlycausedbyprolongedsecondstageoflaborCommonlycausedduringassistedlabortechniquessuchasvacuum-assistedvaginaldeliveriesMayalsobecommoninlabordystociafrompressureofpresentingpartoftheheadthroughbirthingcanalCanbecausedbyforcep-assistedvaginaldeliveriesbutlesscommoncomparedtovacuumorlabordystocia...SymptomsJaundiceAnemiaHypotensionIrritabilityPoorFeeding...RisksCephalohematomasmaytakeweekstoresolveasthebabyslowlyresorbsthebloodclotMaymaskanunderlyinglinearskullfractureHighriskformeningitisorosteomyelitisRuleoutsubgalealhemorrhageCoagulopathy?...Cephalohematoma...SubgalealHemorrhageBleedingbetweentheperiosteumandthescalpgalealaponeurosisEtiologyandsignssimilartoCephalohematomaCrossessuturelines!MaypresentashemorrhagicshockThisareamayholdupto50%ofthebaby’sbloodvolumeCanpresentacrossentirescalp...CausesAlmostalwayscausedsolelybyvacuum-assistedvaginaldeliveriesIntensepressurerequiredtocreateseparationbetweenaponeurosisandperiosteumSteadytractionduringvaccum-assisteddeliverieslowersrisk...ManagementRuleoutCoagulopathyVigilantObservationJaundice,Anemia,Neurologicalsymptoms,VitalsignsNEVERevacuatehematoma:highriskofinfectionAbscess,meningitis,osteomyelitisPhototherapyifjaundicedSkullX-rayorCTtoruleoutfracturesOrderifneurologicalfindingspresentonexamMaytakeacoupleofmonthstoresolvePatienteducation:course,importanceofobservation,anticipatoryguidanceonsignsofinfection,jaundice,orhemorrhage...SubgalealHemorrhage...CaputSuccedaneumSerosanguinous,subcutaneous,and/orperiostealfluidcollectionwithpoorlydefinedmarginsBleedingbelowthescalpandabovetheperiosteum...CauseSameasaboveMostcommonlycausedbypressureofpresentingpartofthecraniumpushingagainstthedilatingcervixduringlaborTourniqueteffect...SignsSimilartoaboveScalpswellingthatextendsoversuturelinesandassociatedwithheadmoldingCommonfindingissuperficialbruising/edemaduetotourniqueteffectandsuperficiallocationUnlikepreviousdisorders,itusuallyisasymptomaticanddoesnotpresentwithsymptomsotherthanscalpswelling...ManagementObservation,Observation,andmoreObservationCommonlyresolveswithinfirstweeksoflifeEducateparentsthatscalpshapeshouldreturntonormalAnticipatoryguidanceonsignstoreturntoER:jaundice,anemia,neurologicalfindings(changeinactivityorfeeding)andsignsofshock...CaputSuccedaneum...ReferencesAAPTextbookofPediatricsDamosJR,BassettR.ChapterH:assistedvaginaldelivery.In:AdvancedLifeSupportinObstetrics(ALSO)ProviderSyllabus.4thed.Leawood,Kan.RonaldS.Gibbs;DavidN.Danforth;BethYKarlan;ArthurFHaney(2008).Danforth'sobstetricsandgynecology.LippincottWilliams&Wilkins.p.

470.RosenbergA.Traumaticbirthinjury.NeoReviews2003;4:270.UpToDate:NeonatalBirthInjuries.Retrieved10-3-2013U.S.FoodandDrugAdministration,CenterforDevicesandRadiologicalHealth.FDApublichealthadvisory:nee