Cephalohematoma In Newborns: Causes, Symptoms And Treatment

Infant cephalohematoma is a birth injury in which blood accumulates between the scalp and the skull’s periosteum (outer membrane). The blood can be from ruptured blood vessels caused by head injuries during delivery. This may not cause pressure on the brain since the blood is pooled on top of the skull.

Although cephalohematomas may resolve themselves in most babies, prompt medical care is recommended for larger hematomas to avoid complications, such as infections, anemia, and jaundice.

Read this post to know about the types, symptoms, causes, risk factors, diagnosis, and treatment of infant cephalohematoma.

Types Of Newborn Cephalohematomas

Infant hematoma can be of two types (1).

• Acute infant hematoma: This may occur immediately or within a few hours after delivery.
• Chronic infant hematoma: The onset of hematoma symptoms may happen a few days or weeks after birth.

Most babies with acute hematomas may be detected on diagnostic tests such as an ultrasound. Close monitoring is recommended for a better prognosis.

Signs And Symptoms Of Infant Cephalohematoma

Cephalohematoma feels like a soft-raised bulging area on your baby’s scalp. The skin above the bump is not discolored or transilluminated. The underlying bone determines the boundaries of cephalohematoma. It means the blood accumulation is confined to the top of one skull bone and does not cross suture lines.

Some of the other signs and symptoms of a large cephalohematoma in infants may include the following (1).

• High-pitched cry
• Feeding problems
• Seizures
• Increased head size (head circumference)
• Fatigue
• Vomiting
• Swelling on the scalp
• Bulging fontanelles or soft spots

These signs and symptoms may be observed immediately after delivery, or within a few days after birth. They could also occur in other neurologic conditions. Therefore, please see a pediatric doctor to determine the precise cause.

Causes Of Infant Cephalohematomas

Delivery-related head injuries are the primary cause of infant cephalohematomas. The baby’s head is usually pushed against the mother’s pelvis during delivery, increasing the chances of a birth injury.

Some of the other common causes of newborn cephalohematomas may include the following (2).

• Infant size: Babies with larger head sizes (macrosomia) are more likely to develop cephalohematoma while passing through the birth canal during delivery.

• Prolonged labor: Infant heads may stay compressed for a long time in the birth canal if labor is prolonged.

• Smaller pelvis: Cephalohematoma may also occur if the baby’s head size is bigger relative to the mother’s pelvic circumference. Thus, a baby with a normal head size may also have this injury if the mother’s pelvis is smaller than usual.

• Assisted-delivery devices: Forceps or vacuum-assisted vaginal delivery may cause cephalohematoma in newborns, since these devices may exert temporary pressure on the baby’s head.

• Medical negligence: Sometimes medical negligence can be the reason for cephalohematomas in some babies, when it is not monitored closely enough by the healthcare team.

• Medical malpractice: Misuse or improper use of assisted devices or tools during delivery and failure to address fetal distress is considered medical malpractice. Tools are only used as per protocol to assist vaginal deliveries.

Cephalohematoma may not occur in all babies due to the above-listed conditions or situations. Parents may be able to claim compensation if birth injuries due to medical negligence or medical malpractice are the cause of cephalohematoma.

Risk Factors For Infant Cephalohematomas

The following factors may increase the risk of developing cephalohematoma in babies (1).

• Male gender
• Mother who has undergone multiple births
• Large fetal size
• Prolonged labor
• Posterior or breech position
• Premature birth
• Use of forceps or vacuum extractor
• Mother unable to push due to weak or ineffective uterine contractions

Possible Complications Of Newborn Cephalohematoma

Possible complications of cephalohematoma in babies may include the following (3).

• Anemia: Deficiency of red blood cells causes anemia. Cephalohematoma causes accumulation of blood, and this blood loss could cause anemia.

• Calcification: This may rarely occur if the cephalohematoma takes several weeks to resolve. Bone tissue could deposit around the accumulated blood, hardening over time. Calcification of cephalohematomas may result in skull deformities.

• Skull fracture: Cephalohematoma may increase the risk of skull fracture in some babies. This is usually not a severe problem and often resolves with minimal medical care.

• Jaundice: Bilirubin levels may go high when the blood cells from the hematoma break down. Jaundice could cause yellowing of the baby’s skin, mostly noticed on sclera (whites of the eye), face and chest. Bilirubin is usually metabolized in the liver and eliminated in urine and stool. If left untreated or not metabolized well, excess bilirubin may cause kernicterus. This is a condition when increased bilirubin levels cause irreversible brain damage.

• Infections: Pooled blood may get infected and often result in sepsis and meningitis. This is the most potentially dangerous and fatal complication of cephalohematoma. The most common bacteria causing this infection is E.coli. Timely drainage of the infection and I.V antibiotics are recommended.

Infections and jaundice due to cephalohematoma could be life-threatening. Timely diagnosis and treatment are vital to prevent complications.

Diagnosis Of Infant Cephalohematoma

Doctors will examine the baby for signs of cephalohematoma and measure serial head size. A hematocrit test is often ordered to see the proportion of red blood cells in the blood. This can be lower than normal in some cases of cephalohematomas.

Imaging tests such as Ultrasound, MRI and CT, may help identify the cephalohematoma’s size and location. Additional blood tests, to determine jaundice (bilirubin levels) and anemia are ordered if needed.

Treatment For Infant Cephalohematoma

Primary treatment is observation. Treatment options for infant cephalohematoma may vary depending on the severity and complications (1).

• Surgeries are done to remove large clots, calcifications, drain abscess, or ligate a bleeding vein
• Intravenous antibiotics are used for infections such as sepsis and meningitis
• Phototherapy and monitoring are done for jaundice
• Monitoring and rest is recommended for skull fractures in babies
• Blood transfusion done for babies with severe anemia

Prenatal care may help to reduce the risk of cephalohematoma in many babies. Doctors may suggest cesarean section if there are risk factors for birth injuries due to large fetal size or prolonged labor. You may discuss with your healthcare provider to know the best delivery method for you.

Cephalohematoma And Caput Succedaneum

Cephalohematoma and caput succedaneum may cause swelling or bump on the baby’s head. Caput succedaneum is edema or swelling under the scalp but above the periosteum due to pressure on the head during the delivery process. In cephalohematoma, the blood vessels under the scalp are ruptured, and the bump contains blood (3).

Caput succedaneum is seen immediately after birth in most babies and can sometimes lead to bleeding underneath the scalp. It resolves within a few days and requires no treatment.

Infant cephalohematoma may not cause any physical or developmental delays in babies. However, early diagnosis and treatment are vital to avoid complications.

References

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