Perinatal morbidity meeting

Bhavani Kalavalapalli
18th October 2010
 Baby SS
• Term baby
• Spontaneous onset of labour
• Failed ventouse
• Forceps delivery
 Resus at birth
• Born in poor condition – SHO at delivery
• No resp effort, floppy and blue but HR >100
• Pinked up quickly with inflation breaths but no
spontaneous resp effort
• First gasp at 5 min followed by irregular resp
• Regular resps by 10min of age
• Cried at 18min of age
• HR >100 throughout
• Cord gases – art pH – 6.8, ven – 6.8
 Progress on the NNU
• Resp system – remained self ventilating in air
• CVS - No concerns
• Gen examination
– Forceps marks on the face
– Deep abrasion on the corner of the right eye
• Neurology – no abnormal movements noted but had
left sided facial nerve palsy
– Noted at birth
• GI system – deranged LFTs – normalised by D3
• Renal – Deranged renal functions – normalised by D3
 Progress - contd
• Sepsis – Started on Benzyl penicillin and
gentamicin
– CRP increased to 20 on D2 – continued antibiotics for
5 days
– Blood cultures negative and clinically remained well
• Fluids – Enteral feeds started on D2 and by the
time of discharge demand breast feeding well
• Haematology – initially normal platelets but had
thrombocytopenia on D2 – and slowly
normalised by D5
 Impression
• SS had hypoxia and evidence of ischaemia to
liver and kidneys
• But never had encephalopathy
• Had HI but not E
• So never qualified the criteria for cooling
• Facial nerve palsy probably secondary to the
difficult delivery
 Outcome
• Baby discharge home on D7
• Demand breast feeding well
• Facial nerve palsy resolving at the time of
discharge
• Due to be seen in the clinic soon
 Facial nerve palsy at birth
• 0.8-2.1 per 1000 births, 88% are associated
with a difficult labour
• Traumatic and developmental
– Of patients with birth trauma, 67-91% are
associated with forceps delivery.
• Risk factors
– forceps delivery
– birth weight of more than 3500 g
– primiparity
 Developmental causes
• Mobius syndrome
• Hemifacial microsomia
• 22q11.2 deletion sydrome
• Osteopetrosis
• CHARGE syndrome
• Facioscapulohumoral muscular dystrophy
• Terratogens
– Thalidomide
– Misoprostol
 Management
• Most traumatic causes resolve spontaneously
(>90%)
• Indications for surgical repair
– complete unilateral paralysis
– evidence of temporal bone trauma based upon CT
scanning and physical examination
– complete loss of function of the facial nerve at age 3-
5 days
– absence of improvement by age 5 weeks
• Surgery delayed until later in life.
Any questions??
 Summary
• >80% facial nerve palsies are traumatic
• >90% of them spontaneously resolve