Birth Trauma: Intra-Abdominal Injury

Intra-abdominal injury is relatively uncommon and can sometimes be overlooked as a cause of death in the newborn. Hemorrhage is the most serious acute complication, and the liver is the most commonly damaged internal organ.

Signs and symptoms of intraperitoneal bleed

Bleeding may be fulminant or insidious, but patients ultimately present with circulatory collapse. Intra-abdominal bleeding should be considered for every infant presenting with shock, pallor, unexplained anemia, and abdominal distension. Overlying abdominal skin may have bluish discoloration. Radiographic findings are not diagnostic but may suggest free peritoneal fluid. Paracentesis is the procedure of choice.

Hepatic rupture

The most common lesion is subcapsular hematoma, which increases to 4-5 cm before rupturing. Symptoms of shock may be delayed. Lacerations are less common, often caused by abnormal pull on peritoneal support ligaments or effect of excessive pressure by the costal margin. Infants with hepatomegaly may be at higher risk. Other predisposing factors include prematurity, postmaturity, coagulation disorders, and asphyxia. In cases associated with asphyxia, vigorous resuscitative effort (often by unusual methods) is the culprit. Splenic rupture is at least a fifth as common as liver laceration. Predisposing factors and mechanisms of injury are similar.

Rapid identification and stabilization of the infant are the keys to management, along with assessment of coagulation defect. Blood transfusion is the most urgent initial step. Persistent coagulopathy may be treated with fresh frozen plasma, transfusion of platelets, and other measures.

Hepatic rupture has no specific racial predilection and has equal sex distribution. Patients usually present immediately following birth, or rupture becomes obvious within the first few hours or days.

• Soft Tissue Injury
• Cranial Nerve and Spinal Cord Injury
• Bone Injury
• Peripheral Nerve Injury
• Intra-Abdominal Injury

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Birth Injury Links

• Birth Injury - EMedicine

Provides general information about birth injuries and other resources.

• Birth Injury - United Cerebral Palsy in Philadelphia

Homepage to the United Cerebral Palsy of Philadelphia organization.