DISEASES OF THE NEWBORN A part of these injuries are attributable to the physician or nurse, some are de pendent on a disproportion between the size of the child and the width of the pelvis, others are due to disturbance of the placental blood supply from contraction of the uterus and compression of the cord.
The physician should make a careful examination of every new born infant to ascertain whether any birth injuries have occurred. The majority of injuries are found in cases where no artificial aid has been employed. Dittrich classifies birth injuries as follows: 1. Abrasions of the skin.
2. Ecchymoses of the skin.
3. Wounds of the soft parts.
4. Fractures and injuries of the bones.
5. Ruptures of internal organs.
6. Tearing oft entire portions of the body.
Abrasions and open wounds of the cutaneous surface may he produced by the finger of the examining physician or midwife; by instruments or through the pressure of the bony pelvic ring and possibly by exost.oses or tumors of the latter.
The pressure marks caused by projecting parts of the pelvic rim, especially the promontory, are of especial value to the accoucher, giv ing information concerning the foetal presentation and the mechanism of labor; they form more or less intensive areas of redness in the skin, striated and often containing htemorrhages. In case the pressure operates for a longer time necrosis of the skin occurs as a result of the interference with its nutrition. These pressure marks occur most often with vertex presentations.
The application of forceps often leads to circumscribed compres sions over the cranial and facial bones and in consequence to suggil lations and (edemas, excoriatious and sometimes necroses of the skin.
The wounds of the skin, covered with granulations, which are occasionally encountered in children immediately after birth must be ascribed to the tearing away of earlier formed adhesions of the skin to amniotic bands.
H=orrhages occur frequently in unassisted as well as assisted labors. They are in part traumatic in origin, in part, however, due to interruption in the placental circulation through compression of the cord, or to asphyxia. The haemorrhages into the skin are mostly only
punctate and very rarely assume larger proportions. Among the haemorrhages of other organs the most frequent are ceph ahumatomata, and heni a tomata of the sternocleido mastoid muscle, which will be taken up in detail later; also hamorrhages of the cra nial and spinal meninges and into the substance and cavi ties of the brain and cord.
Meningeal and cerebral haemorrhages are frequent, as a rule, giving rise to no symptoms; only occasionally symptoms of increased in tracranial pressure—evident cerebral compression, slowing of the pulse, arrhythmic, su perficial, intermittent respirations; protuberant or tense fontanelle, con vulsions, and paralysis—are observed immediately after birth. Many of these children are apparently born dead, some are normal at first but on the second or third day the breathing becomes shallow (Kundrat) and the children die with the manifestations of asphyxia or pulmonary at electasis.
Convulsions.—In less acute cases attention is called to the menin geal bleeding by the occurrence of eclamptic attacks. The spasms may be bilateral or unilateral or may, moreover, be limited to a single extremity, to one half of the face or to the eyes. They- may cease occur ring after a short time (just as the paralysis) or continuing, be the indicator of a permanent disturbance of the cerebral function.
We are doubtless justified, in occasional cases, in holding birth injuries responsible for permanent impairment of the brain function of the nature of epilepsy, paralyses, idiocy, etc. (Concerning this question reference is made to the chapter on Nervous Diseases.) The diagnosis of meningeal !emorrhages in the newborn might probably be confirmed by lumbar puncture: Finkelstein was fortunate enough to accomplish this in one case. The drawing off, on puncture, of a hemorrhagic fluid does not suffice for making a diagnosis, as this might be clue to the puncturing of a vessel. One must find red cells which are altered morphologically, possibly casts or cell detritus. Kundrat has written explicitly concerning hemorrhages localized in the meninges.