Birth Injuries Health Article

Definition

A birth injury is defined by the Centers for Disease Control and Prevention (CDC) as an impairment of the neonate's (a newborn; usually less than one-month old) body function or structure caused by adverse influences occurring at birth.

Description

Birth injuries can occur during any birth. In the CDC's April 1999 report on vital statistics, birth injuries were highest when mothers were 25 to 29 years of age and lowest when mothers were 40 to 54 years old. Birth injuries include:

• asphyxia
• shoulder dystocia
• brachial plexus injury
• fractures of the clavicle and humerus
• fractures of the long bones
• cerebral injury
• cephalhematoma
• facial nerve palsy

Causes and symptoms

Infants of diabetic mothers are particularly at risk for birth injuries due to macrosomia (large body size). Macrosomia is a problem in about 33% of diabetic pregnancies, even with efforts for strong glycemic control. However, when glycemic control approximates normal blood glucose levels, injury rates are reduced. Macrosomia is also a problem associated with multiparity (at least two births of a large infant by the same woman) because, with each pregnancy, the developing infant tends to be larger than its predecessor. A post-due date infant can also result in a large infant. When gestational age fetuses are large, they stretch the uterus, which can result in dysfunction during labor or delivery and increase the risk for postpartum hemorrhage. Larger infants have a 15% perinatal mortality rate versus the 4% mortality rate of appropriately sized neonates. Large infants born vaginally also have a higher than normal risk of shoulder dystocia, resulting in nerve injuries or fractured clavicle. In general, birth injuries are more likely to occur during a difficult vaginal birth, with prolonged labor, use of instrumentation such as forceps or vacuum extractor, with cephalopelvic disproportion, with fetal malpresentation, or during a Caesarian delivery. The injury may occur during labor, delivery, or neonatal resuscitation. Infants born preterm are especially at risk for birth injuries. One reason for this is the relationship between prenatal infections and preterm birth. Prenatal infection appears to play a significant role in premature delivery.