Head Trauma In NewBorn Baby

Nurul Istiqomah J210102006 International Nursing Health Science Faculty UMS

HEAD TRAUMA
Head trauma that occure during the birth process is usually benign but occasionally result in more serious injury.

Injuries that result serious trauma : Intracranial hemorrage subdural hematoma

3 most common types of extracranial hemorrhagic injury:

Caput succedaneum Subgaleal hemorrage Cephalhematoma

 Caput Succedaneum

A vaguely outlined area of edematous tissue situated over the portion of the scalp that present in a vertex delivery The swelling consist of serum,blood that has accumulated in the tissues above the bone The swelling beyond the sutures The swelling may be assosiated with overlying petechiae/ecchymosis Occure at shortly after birth No specific treatment,subsides within a few days

 Subgaleal Hemorrhage Is bleeding into the subgaleal compartment Subgaleal compartment : potential space contains loosely arranged connective tissue Located : beneath the galea aponeurosis It occure as a result of forces that compress and drag the head through the pelvic outlet The bleeding extend beyond bone,often posterior into the neck,continue after birth,potential for serious complications and morbidity Other sign: pallor, tachycardia, a forward and lateral positioning of the new borns ear as the hematoma extends posteriorly,increasing head circumference Commuted tomography (CT) is usefull in confirming the diagnosis Replacement of lost blood and clothing factors is required in acute cases of hemorrage. Monitoring for change in level consciousness & decrease in the hematocrit An increase in serum bilirubin levels occure as result of the degrading blood cells within the hematoma

 Cephalhematoma Blood vesseles rupture during labor/delivery to produce bleeding into the area between the bone and its periosteum Occure most often with primiparous women and is often assosiated with forceps delivery and vacuum extraction. Cephalhematoma: distinguishable and do not extend beyond the limits of the bone No treatment is indicated for uncomplicated it Most lesion are absorbed within 2weeks-3months Hyperbilirubinemia may result during resolution of the hematoma

 Nursing Care Management 1. Assesment and observation of the common scalp injuries and vigilance in oberving for possible assosiated complications 2. Such as : skin breakdown,infection,acute blood loss,hypovolemia 3. Because caput and cephalhematoma injuries resolve spontaneusly 4. Parents need reassurance of their usual benign nature.

Hyperbilirubinemia

Hyperbilirubinemia
Hyperbilirubinemia : excessive level of accumulated bilirubin in the blood. is characterized by jaundice / icterus. May result from increased unconjugated / conjugated bilirubin Total serum bilirubin is measured to determine the degree of bilirubinemia Normal value of conjugated bilirubin are 0,2-0,4 mg/dl. In the new born level must exceed 5mg/dl before jaundice is observebel

 Factor that evaluated:

o Appearance of clinical jaundice within 24 hours of birth o Persistant clinical jaundice over 2 weeks in full term, formula feed infant o Total serm bilirubin level > 12,9 mg/dl (term infant), >15mg/dl (preterm infant), upper limit breast feed infant: 15mg/dl o Increase in serum bilirubin by 5 mg/dl/day o Caused by indirect bilirubin

Following are risk factor of high risk for hyperbilirubinemia: Maternal race Gestational age 35-36 weeks Significant bruising Exclusive breast feeding Hemolytic disease History sibling with hyperbilirubinemia

 Noninfansive monitoring of bilirubin via cutaneus reflectance measurements Transutaneus bilirubinometry TcB The use of hour-specific serum bilirubin levels to predict newborn at risk for rapidly rising level has now become an official recommendation by Academ of Pediatrics (2004)

 Pathophysiology

Bilirubin is one of the breakdown product of haemoglobin that result from red blood cell (RBC) destruction ( setelah beberapa hari bayi lahir) Pathologic factor: process interferes with balance of destruction with RBC and excertion of any products( kuningnya menyeluruh, bisa menburuk, terjadi saat bayi lahir) Cause of hiperbilirubunia: Physiologic(developmental) factors (prematurity) An association with breast feeding( pemberian ASI nya kurang ) Excess production of bilirubin ( ada golongan darah yang tidak cocok antara ibu dan anak,jadi ada distruction yng berelebih ) Disturbed capacity of the liver to secret conjugated bilirubin Combined over production and under excretion ( premature,lack of enzim,lack of albumin) Some condition or disease state Genetic prediposition to incresed production

 Complications: Bilirubin enephalopaty: a term that describes varying degrees of CNS damage resulting from the deosition og unconjugated bilirubin in brain cell Kernictres: yellow staining of the brain cells that may result in bilirubin encepalopathy.
Bilirubin encephalopathy: acidocis, lowered serum

albumin levels,intracradial infections such as meningitis,and abrupt fluctuations in the blood. Increased metabolic demans for oxygen or glucose

 Physiologic jaundice
Relatively mild and self limited physiologic jaundice/icterus neonatum Phsiologic jaundice is not associated with any patologic process

Mechanism involved in physiologic jaundice

Newborns produce twice as much bilirubin as do adults because of higher concentrations of circulating erythrocytes and shorter life span of RBCs (only 70 to 90 days ) The livers ability to conjugate bilirubin is reduce becaise of limited production of glucuronyl transferase. Newborns also have a lower plasma binding capacity for biliubin because of lower albumin concentrations than older children.

 Jaundice in breast-feeding infants

Decreased caloric and fluid intake by breast-fed infants before the milk supply is well established,since fasting is associated with decreased hepatic clearance of bilirubin Begins around the fourth day and occurs in 2%to 4%of breat feed infants(blackburn,2007) Rising level of bilirubin peak during the second week & gradually diminish Despite high levels of bilirubin that may persist for 3 to 12 weeks,these infant are well

 Clinical manifestations of breast-feeding jaundice

The most obvious sign of hyperbilirubinemia is jaundice,the yellowish discoloration primaly of the sclera,nails,or skin. Jaundice that appears within the first 24 hours is caused by HDN,sepsis,or one of the maternally derived disease srch as diabetes mellitus or infections. Jaundice that appears on the second or third day ,peaks on the third to fifth day,and declines on the fifth to seventh day is ussually result of physiologic jaundice : ethnic origin

 Therapeutic management
Phototherapy: consist of exposing the infants skin to an approproate light source ( uv/blue light) Phenobarbital:
1.

promotes hepatic glucoronyl transferase synthesis, which increase bilirubin conjugation and hepatic clearance of the pigment in bile. 2. Protein ynthesis,which may increases albumin for more bilirubin binding sites.

 Phototheray
The infants who recieves phototherapy is placed under the light source, exposing as much skin surface as possible, and repotioned frequenly to expose all body surface areas to the light For phototherapy to be active, the infants skin must be usually exposed to an adequate amount of light or irradiance. When serum bilirubin levels are rapidly increasing or approximating critical levels,double or intensive phototherapy is recommended

 The color of the infants skin doesnt influence the efficacy of pototherapy Best result : the first 24 to 48 hours of treatment It is not effective in the management of hyperbilirubinemia in criticaly level

It is can effective in mild to moderate hyperbilirubinemia The effectiveness of treatment of mild to moderate hyperbilirubinemia An opaque mask shields the infants eyes to prevent exposure to the light (check every 4 to 6 hours

 Nursing resposibility :
1. 2.

3. 4. 5.

6.
7. 8.

Times that phototherapy is started and stoped Proper shield of the eyes(an opaque mask), genital with mask ( especialy for man baby) for retina and testis. (dgn kain memancarkan cahaya spt putih) Type of phtotherapy unit(by manufacture) Number of lamps Distance between surface of lamp and infant based on the manufactures guidlines ( 2030cm,45 cm ) Use of phototherapy in combinationwith an incubator or open basinet Photometer measurement of light intensity (microwatt) Side effects

 Side effect of phototherapy Minor side: loose, greenish stool, transient skin rashes, mild hyperthermia, increased metabolik rate, priapism. To prevent these effects: monitor the temperature to detect early sign of hyper or hypothermia Oil lubricans or lotions are not use on the skin to prevent increased tanning(harrus dlm keadaan kering) Frequent stooling can cause perianal irritation