Newborn Cephalohematoma Complications

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Why Do Babies Have Cephalohematoma?

Cephalohematoma is a pooling of blood in the layers of tissue between the skin and the skull. It’s often caused by prolonged labor (from the time of dilation to delivery of the infant), or an injury from forceps delivery or vacuum extractor.

Technically, cephalohematoma is a collection of blood caused by break of vessels beneath the periosteum, a collection of connective tissue under the skin. Cephalohematomas are usually found over the parietal or occipital bone. The swelling may or may coincide with the discolored area. The cephalohematoma rarely expands after delivery, and does not generally cause significant blood loss. Cephalohematoma is estimated to happen in 1 to 2 percent of all deliveries and is much more common with prolonged labor and when forceps or vacuum delivery is performed.

Vacuum delivery is often thought of as being “easier” than forceps delivery, but several medical studies have shown that cephalohematomas are more common after vacuum delivery than after the use of forceps. (The same is also true of retinal hemorrhage and shoulder dystocia.)


Are There Any Dangers To A Cephalohematoma?

A cephalohematoma isn’t necessarily dangerous by itself. Most cephalohematomas will resolve spontaneously over the course of a few weeks without any treatment. However, hardening of the hematoma can happen if the cephalohematoma lasts for months, including changes in the skull through calcification or ossification. These calcified or ossified hematomas can be treated with surgery.

Other complications of cephalohematoma include infection and sepsis, including with Escherichia coli. Infected cephalohematomas present as puffy, swollen red masses that may have expanded from their baseline size. CT and MRI imaging is helpful diagnosing them, and a biopsy should be done. Bone infections, called osteomyelitis, can happen with an infected cephalohematoma. Treatment includes draining the abscess and cutting away and necrotic tissue, along with a long course of the antibiotics vancomycin, gentamicin, or cefotaxime.


Cephalohematomas Can Be A Sign Of Other Medical Issues

Cephalohematomas are rarely harmful on their own, but they can indicate that a newborn has other medical issues that need attention. For example, cephalohematomas are one of the most common signs of an intracranial epidural hematoma (a bleed within the brain). If a newborn has a cephalohematoma along with a scalp hematoma, irritability, vomiting, a bulging fontanelle, or pallor with anemia, they should be given a head CT scan to look for bleeding within the brain. Similarly, cephalohematomas are more common in newborns with hemophilia and anemia, and so should put doctors on guard for these issues.

Cephalohematomas and other bruises from birth trauma are also risk factors for hyperbilirubinemia, which happens when the newborn’s body can’t break down blood toxins fast enough. A cephalohematoma, particularly with jaundice, can also be an early warning sign of kernicterus. Similarly, the bleeding from a cephalohematoma can lead to increased potassium release. Finally, cephalohematomas are also correlated with skull flattening, called plagiocephaly.