Cephalohematoma – Newborn Birth Injuries Risk Factors

Cephalohematoma (CH) is a traumatic subperiosteal hematoma that occurs underneath the skin. It mostly happens in the periosteum of the infant’s skull bone.

The hemorrhage of blood between the skull and the periosteum rarely occurs in grownups.

Infant cephalohematoma may lead to the unwanted pooling of blood from the damaged blood vessels between the skull and the inner layers of the scalp skin. A collection of blood gets accumulated under the skin of the scalp.

Fortunately, cephalohematoma does not cause serious risks to the brain cells or the development of the brain. The blood that is pooled outside the skull does not enter the brain cells.

Nearly 2 percent of the babies in the world are born to develop CH during or after birth. It occurs when blood vessels under the scalp’s skin get damaged during labor and delivery.

What causes Cephalohematomas?

Typically, a baby’s Cephalohematoma is caused by birth injuries and trauma during delivery. When a baby’s outer layer of the skull is injured, blood collects in the skull’s periosteum, causing a cephalohematoma.

The prime reason for a newborn hematoma in a majority of babies is a minor injury to the scalp of the child during labor or delivery.

An injury to the scalp of the baby can happen if the head of the baby is larger than the mother’s pelvic area. The baby’s scalp may get injured if the baby’s head hits the mother’s pelvis during labor. It involves the premature rupture of fetal membranes.

When a woman takes a longer time to deliver, for a longer duration, the baby’s head is compressed by the birth canal. This is the most common reason for cephalohematoma.

Improper use of birth-assisting devices like a vacuum or forceps may cause injuries to a baby’s scalp. Birth-help devices are necessary to help the woman during labor, but this, in turn, increases the baby’s risk for cephalohematoma.

Even when a woman is in perfectly normal labor, some amount of stress and compression is exerted on the infant’s head, leading to bruising, swelling, and cephalohematoma.

Also, inexperienced handling of a vacuum extractor during delivery may increase the possibility of cephalohematoma formation, head trauma, or subgaleal hemorrhage.

Symptoms

If your baby has an unusual bulge anywhere on its skull, it could be a CH issue. The bulge on the top of the skull does not show any bruises or cuts on the surface of the skin.

After a week or so, the bulge under the skin may become harder and more stubborn as the blood calcifies.

However, after a few weeks, the bulge shrinks as the calcified blood gradually disappears. In some cases, the center of the bulge disappears before the edges. In such cases, CH has a crater-like appearance where the bulge once existed.

The severity of symptoms may vary for each child. The baby may also show any of the following internal symptoms:

  • infection leading to osteomyelitis or meningitis
  • jaundice
  • anemia or low blood cells counts
  • behavioral differences like hypotension
  • scalp bleeding called subgaleal hemorrhage

Diagnosis of cephalohematomas

Generally, the physician performs a full-body physical examination of your infant to diagnose CH.

A specialist doctor can easily identify the disease by examining the characteristics of the bulge on the top of the skull.

For diagnosing CH, your child may be subjected to other lab tests such as:

  • MRI scan
  • X-ray
  • CT Scan
  • Ultrasound

The diagnostic tests help to identify the CH problem and other complications in the scalp and skull of your baby. As the treatment for the CH is in progress, you should constantly monitor your child for any changes in symptoms, including jaundice and anemia.

Neonatal External Injuries

Conditions leading to Cephalohematoma

Most infants experience some negligible level of CH development. Generally, it will disappear within a week or month without any treatment.  However, there are a few factors that can increase the risk of injury.

The risk of possible bruises and injuries to the head of the baby may increase with the use of birth-assisting devices. Nonetheless, the use of such devices becomes necessary for women who have complicated delivery or long labor.

Here are the other factors that increase the risk of CH:

  • Small birth canal
  • Large baby has a slow and compressed movement through the birth canal
  • Use of certain medications like pain relievers that can weaken the contraction of the birth canal
  • Mothers carrying twins or triplets
  • When the infant is not in a head-down position or back-facing position
  • Weak uterine contractions that do not give a strong push to the infant into the birth canal
  • Vacuum-assisted birth

Treatments

Cephalohematoma is not a serious health condition. In most cases, an infant does not need any special treatment for CH.

Treatment for CH is necessary only if the infant is suffering from additional problems such as jaundice, low blood counts, or other problems.

Within a couple of weeks, the head injuries will recuperate on their own. Usually, within 3 months after the birth of the baby, the CH injuries on the scalp will totally disappear with no traces of the injuries left behind.

However, if there is an unusually excessive amount of blood pooled under the scalp skin, your doctor may drain out the pooled blood. Such treatments can cause minor infections on infants’ scalps in the absence of reasonable care.

If a baby develops anemia, a blood transfusion may be necessary.

Possible complications

It is not a serious health condition. The blood pooling under the scalp skin stays only for a few weeks and gradually disappears.

Normally, no long-term complications arise from the CH issue. You need not fear any health hazards or developmental delays as a result of the injury.

However, CH can increase the risk of anemia and jaundice.

Your doctor might recommend a blood transfusion for your baby if severe anemia happens to your baby. The blood pooling resulting from CH causes a low count of red blood cells. Blood transfusions become necessary for this reason.

Babies with CH conditions are susceptible to developing jaundice infection. It is because of excess bilirubin (yellow pigment) in the blood.

Jaundice happens as the blood from CH breaks down and gets reabsorbed, leading to excess production of bilirubin in the baby’s blood.

If you notice any yellowish discoloration of the skin or eyes, your baby may have jaundice. Your doctor can do a phototherapy treatment to cure jaundice. Light therapy helps in breaking down excess bilirubin, and it then expels them from the baby’s body via stool and urine.

Infant’s cephalohematoma care

As soon as you notice any unusual bumps on your baby’s scalp, make sure to get your baby checked by a doctor. The doctor may conduct diagnostic tests like CT or MRI scanning to identify the gravity of the issue.

Usually, no medicines are required for CH unless associated issues like jaundice or anemia come up with it. Normally, CH will heal on its own within a few weeks or a maximum of 90 days after birth.

In some cases, the doctor may attempt to drain out the excess accumulation of blood, but this may cause infection or abscess formation if not cared for well.

Infants with CH condition need to be regularly examined diagnosing the possible occurrence of jaundice and anemia.

The doctor may recommend a blood transfusion if your baby has severe anemia.

Although the healing of CH issues heals on its own, it is still essential to monitor and observe the proper healing of this condition regularly.

If your child’s hematoma was caused by improper care by the medical team, your family may be entitled to financial compensation.

Cephalohematoma – Newborn Birth Injuries Risk Factors 1

Caput Succedaneum vs. Cephalohematoma

Caput succedaneum (also called caput or newborn conehead) has unusual bumps on the newborn baby’s head like cephalohematoma.

Caput is caused by scalp swelling due to pressure, while CH is caused by bleeding under the scalp.

Cephalohematoma and caput succedaneum may occur together or separately.

Both these injuries are not serious in most cases. Occasionally, they can result in other potential complications like jaundice and infection if not properly handled.

Allow the conditions to clear on their own. In most cases, they will go away without treatment. Attempting to drain the excess fluid from the infant’s head can cause infection.

The symptoms of caput succedaneum include a delicate swelling on the top of a baby’s head. The bump looks puffy and it lies just below the outer layer of skin covering the head. The swelling appears on the exact side of the baby’s head that first exited the birth canal.

On the other hand, the occurrence of cephalohematoma causes some mild bruising and discoloration in the affected area of the head. It is a more serious condition than caput.

The bottom line

The cephalohematoma issue affects about two percent of newborn children.

In most cases, the baby does not remain in a hospital if they develop CH. Usually, the bulges under the scalp skin disappear within a few weeks without any medication.

In rare cases, it may increase the baby’s risk of developing newborn jaundice due to excessive bilirubin levels in the blood.

However, it is important to regularly monitor the issue to ensure that symptoms do not get worse. Timely treatment is required; otherwise, cephalohematoma may increase the possibility of other health issues such as jaundice or anemia.

There is nothing to panic about the issue as this issue does not impact your child’s brain development or health complications.

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