Birth injury of the cranium and central nervous system

Abstract

Birth injury of the scalp, skull and central nervous system (CNS) is a well-recognized complication of a difficult delivery. The rate of birth trauma has dropped precipitously and now accounts for less than 2% of neonatal deaths. Despite this dramatic decrease in birth-trauma mortality significant injuries still occur. A variety of risk factors clearly predispose certain infants to birth-related injury. Recent neuroradiology studies indicate that intracranial hemorrhage, even in asymptomatic infants, is not rare. Pathologists' (neuropathologists and forensic pathologists) appreciation of the spectrum of birth injuries and their sequelae is critical in order to be able to distinguish these from inflicted injuries and post-mortem changes.

Figure 1

Diagram of sites of hemorrhage in the neonatal CNS coverings (reproduced from Pape KE, Wigglesworth JS (1979) Haemorrhage, Ischaemia and the Perinatal Brain. JB Lippincott: Philadelphia, with permission from JB Lippincott).

Figure 2

Acute subgaleal hemorrhage (arrow), acute cephalhematoma (arrowhead) of a 1‐day‐old infant (concealed pregnancy) delivered into a bathtub‐filled with water that was brought to the attention of authorities when the mother presented to a local Emergency Department because of postpartum bleeding.

Figure 3

Healed cephalhematoma, 3‐month‐old infant delivered vaginally with postpartum diagnosis of cephalhematoma.

Figure 4

Diagram demonstrating occipital osteodiastasis. A. Normal unfused posterior cranial fossa bones of the neonate, B. Occipital osteodiastasis with compression of posterior cranial fossa structures (reproduced from Pape KE, Wigglesworth JS (1979) Haemorrhage, Ischaemia and the Perinatal Brain. JB Lippincott: Philadelphia, with permission from JB Lippincott).

Figure 5

Photograph of macerated fetus with large retroperitoneal mass containing CNS tissue caused by post‐mortem changes (the so‐called primitive neuroectodermal tumor).