Cephalohematoma

Cephalohematoma refers to hemorrhage or bleeding under the skin surface present between the skull and periosteum. It typically occurs in newborns. The layer of thin membrane that covers the external surface of the skull is known as periosteum and is home to varied blood vessels. Hemorrhage occurs due to tearing of these blood vessels. Even though cephalohematoma has some association with a subperiosteal inflammation subtype, it remains isolated above the suture lines due to protection provided by bones in the area.

Bleeding occurs over a period of time. Hence, bursting of blood vessels is not visible immediately after birth of baby. Doctors may notice the signs only several hours later. The blood typically gets reabsorbed in about 14 days to 3 months, but any instances of skull bone breakage or fracture may cause a bony hump post recovery from cephalohematoma.

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Cephalohematoma affects about one/two percent of live births. It is more prevalent in male babies than female babies as well as in deliveries done via use of medical/surgical tools. Bleeding can occur unilaterally or bilaterally; bilateral hemorrhage is observed in 15% of cases.

Cephalohematoma does not cause any injuries to brain cells and bleeding is restricted to the outer part of skull and the deeper skin layers. Cephalohematoma does not cause health complications and resolves without any medical treatment. However, occurrence of any associated neurological problems requires immediate medical care.

Symptoms of cephalohematoma

A few signs and symptoms of cephalohematoma are mentioned below:

  • Swelling of head is observed, but it cannot advance beyond the suture lines that protect the brain. Swelling is defined by clear borders. Swelling tends to be most noticeable on the 2nd or 3rd day after occurrence of cephalohematoma-bleeding.
  • The head of the baby may have anomalous bumps or protrusions. Such bumps tend to be soft if hemorrhage is mild and causes minimal bleeding. Presence of a solid bump is often indicative of large-scale bleeding.
  • There may be calcification of hemorrhage site, but the mid-section of the area is typically supple or softer. This condition is referred to as a depressed skull fracture. Also blood deposits may make the adjacent areas to feel more pliable when touched.
  • If the hemorrhage affects some part of the brain, then re-absorption and recovery will be longer over several weeks. Inflammation which occurs simultaneous also heals slowly.
  • In some cases, cephalohematoma may be a sign of skull-level fracture
  • Severe instances of cephalohematoma may trigger complications like hypotension, jaundice, and/or anemia in affected newborns. There may also be increased risk to infection, which in turn can make the baby more vulnerable to life-threatening conditions like osteomyelitis or meningitis.
    • Infections, hyper-bilirubinemia, and anemia may be complications of cephalohematoma, but it is important to note that infection usually occurs when doctors try to drain the bleeding.

Causes of cephalohematoma

Some of the common causes of cephalohematoma are as follows:

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  • It is more common in women who have become pregnant for the first time
  • There is increased risk if the baby’s head is larger than the mother’s pelvic area
  • Any kind of trauma to the head of baby during labor or other phases of delivery can increase the risk of cephalohematoma
  • There is increased risk of bleeding if the baby’s head bangs one or more times against the bony wall of the pelvis during labor and childbirth
  • The second stage of labor commences after complete dilation and ends after the delivery of the newborn. Prolonged and difficult second stage can trigger bleeding of blood vessels on skull surface.
  • When doctors use ventouse, forceps, or other medical tools for delivery assistance, then there is the possibility of trauma to baby’s head. It can cause the blood vessels to rupture and lead to bleeding
  • Babies with macrosomia or an excessively large head are more prone to blood vessels rupture and hemorrhage
  • Normal delivery of baby poses more risk of cephalohematoma as compared to childbirths performed via C-section.
  • It is important to note that deficiencies of vitamin C do not result in bleeding, but such nutritional deficits do increase the susceptibility to occurrence of cephalohematoma in newborn.

Treatment of cephalohematoma

Cephalohematoma resolves on its own in around three months. Hence, medical treatment is generally not needed.

However, presence of an abnormal bump on the baby’s head or any other irregularities in the size/shape of the head or in the child’s behavior needs to be immediately investigated by a doctor. Subsequently, varied tests will be carried out and the baby will be monitored. Severe cephalohematoma or any associated complications will be treated as per standard medical procedures.

  • Excessive bleeding that leads to anemia or reduction in count of red blood cells may be treated via a blood transfusion.
  • The levels of bilirubin rise when there is breakdown/disintegration of blood cells. Increased bilirubin increases the risk to development of jaundice. Treatment for higher bilirubin levels or jaundice involves phototherapy, etc.
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