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 have positive results on diagnostic tests. Early treatment is recommended for a better prognosis. Untreated acute hematomas may complicate into chronic hematomas in babies.
Signs And Symptoms Of Infant Cephalohematoma
You may notice soft-raised areas on your baby’s scalp due to cephalohematoma. 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 on top of one skull bone and does not cross suture lines.
Some of the other signs and symptoms of cephalohematoma in infants may include the following (1).
- High-pitched cry
- Feeding problems
- Increased head size (head circumference)
- Swelling on the scalp
- Bulging fontanelles or soft spots
Some babies may develop symptoms immediately after the injury. A few may have a longer time gap between injury and onset of symptoms. These symptoms could also occur in other conditions. Therefore, see a 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 injuries.
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 the delivery process.
- Prolonged labor: Infant heads may stay compressed for a longer time in the birth canal if the labor is prolonged.
- Smaller pelvis: Even if the baby has an average head size, there is a risk of head injuries if the mother’s pelvis is smaller than usual.
- Assisted-delivery devices: Forceps or vacuum-assisted deliveries may cause cephalohematoma in newborns. In such cases, labor is also longer, and the devices may exert pressure on the baby’s head.
- Medical negligence: Rarely medical negligence can be the reason for cephalohematomas in some babies. This is when the doctors fail to identify the risks for cephalohematoma and intervene on time as per protocol.
- Medical malpractice: Misuse or improper use of assisted devices or tools during delivery and failure to address fetal distress on an emergency basis is considered medical malpractice. Tools are only used as per protocols to assist 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
- Multiple births
- Large fetus
- 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 stays longer than a month. 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 palms and soles, and sclera (whites of the eye). Bilirubin is usually metabolized in the liver and eliminated in urine. If left untreated or not metabolized well, excess bilirubin may cause kernicterus. This is a condition when increased bilirubin levels cause permanent brain damages.
- Infections: Pooled blood may get infected and often result in sepsis and meningitis. This is the most potentially dangerous and fatal complication of cephalohematoma.
Infections and jaundice due to cephalohematoma could be life-threatening. Timely diagnosis and treatment are vital to prevent complications.
Diagnosis Of Infant Cephalohematoma
Doctors may look for the signs and measure head size to see any unusual size changes. A hematocrit test is often ordered to see the proportion of red blood cells in the blood. This can be lower than normal in the case of cephalohematomas.
Imaging tests such as MRI, CT, and X-rays may help identify the cephalohematoma’s size and location. Additional tests, such as 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 blood, or ligate a bleeding vein
- Antibiotics are prescribed for infections such as sepsis and meningitis
- Light therapy and monitoring is 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 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 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 requires no treatment. It may resolve itself within a few days.
Infant cephalohematoma may not cause any physical or developmental delays in babies. However, early diagnosis and treatment are vital to avoid complications, which may include fatal issues. If the cephalohematoma turns out to be due to medical negligence, you may speak to a lawyer to determine the recommended legal reparation.
2. Cephalohematoma; U.S. National Library of Medicine
3. Caput Succedaneum and Cephalohematoma: The Cs that Leave Bumps on the Head;Academy of Neonatal Nursing