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Tuesday, March 18, 2014

Cephalohematoma






  • This condition refers to a collection of blood under the scalp of the newborn infant. 
  • The blood "lake" is located between the periosteum (the envelope over a bone) and the bone itself.  It does not extend beyond the bone's margin because of the especially tight connection of periosteum-to-bone at the suture line.

  • A bulge over part of the infant's skull, usually over the parietal bone on the side of the head; but definitely located over one of the skull bones and not randomly located 
  • If the blood collection is small, the mass will be soft, mushy.
  • If the blood collection is large, the mass will be firm.

  • Minor injury during labor and delivery
  • At times, cephalopelvic disproportion leads to the injury (that is, the fetal head is large, in comparison to the mother's pelvic outlet)
  • An underlying Fracture of a skull bone can sometimes be demonstrated.

  • The usual parietal location of the blood collection, on the right or left side of the head, suggests the diagnosis.  If the bulging area is soft, then bone can be gently felt underneath (as opposed to feeling a fontanelle underneath). 
  • Whatever the location on the skull, the bulge should correspond to the outlines of one of the skull bones.
  • The bulge does not extend past the outline of one of the skull bones.

  • Primiparous mother (mother's first pregnancy)
  • Large neonatal birthweight
  • At times, forceps delivery

  • Watchful waiting is the usual treatment for an uncomplicated case. 
  • Physicians try not to put a needle into this blood collection because doing so might introduce infection, even with sterile technique. 

  • Anemia, if the blood collection is large
  • If the blood collection is large, the re-absorption of the blood clot will generate a large amount of bilirubin as a breakdown product of this blood.  The bilirubin can cause hyperbilirubinemia (jaundice) of the infant, which may require phototherapy in unusual cases.
  • Infection of the blood collection
  • A minimal Fracture here ordinarily needs no treatment other than supportive care.
  • Occasionally, calcium deposits form in the blood collection if the blood remains there for a long while, and this can cause an unsightly hard bump, but the bump eventually resolves.

  • Discuss with your physician if there is any bulge over the baby's skull, and discuss the possibility of anemia or jaundice, which may occur.

  • Caput Succedaneum, which is a blood collection more superficially located, and not limited to a location right over a skull bone

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