Brief overview
- Course of disease and prognosis: Usually very good, regresses after several weeks to months; sometimes increased neonatal icterus, very rare complications
- Symptoms: Doughy-soft, later turgid-elastic swelling on the newborn’s head
- Causes and risk factors: Shear forces acting on the child’s head during birth, increased risk with assistive devices such as forceps or suction cups
- Examinations and diagnosis: Visible and palpable swelling on the head, ultrasound examination to exclude further head injuries
- Treatment: Usually no treatment necessary
What is a cephalhematoma?
The word cephalhematoma describes a collection of blood on the head of a newborn. “Kephal” comes from Greek and means “belonging to the head.” A hematoma is a bruise or a compact collection of blood in the tissue.
The structure of the skull in newborns
The skull of the newborn is still soft and deformable. On the outside sits the so-called head rind. This includes the scalp with its hair and subcutaneous fatty tissue as well as the hood-like muscle-tendon plate (galea aponeurotica).
Below this lies the skull bone, which consists of several parts. These are not yet firmly fused together in the newborn. The skull bone is covered on both its inside and outside by the so-called periosteum (periosteum). It protects and nourishes the bone.
The cephalhematoma forms between the periosteum and the bone. It is bounded by the edges of the skull bone. This makes it easily distinguishable from another typical swelling of the head in the newborn, the so-called birth tumor.
Unlike cephalhematoma, a birth ulcer crosses the boundaries of the individual bones of the skull and the periosteum remains attached to the bone.
Cephalhematoma: Incidence
In particular, forceps deliveries (forceps deliveries) or suction cup deliveries (vacuum extractions) are associated with the development of cephalhematoma. In these deliveries, the doctor applies either so-called forceps spoons or a vacuum cup to the baby’s head to help him or her into the world.
Cephalhematoma: Are there late effects?
Overall, the prognosis for cephalhematoma is very good. In the first few days after birth, it often increases in size and changes in texture. The initially clotted blood of the hematoma liquefies over time in the process of breakdown. Within a few weeks to months, the hematoma eventually disappears.
In some cases, however, the edges of the cephalhematoma calcify along the cranial sutures and remain palpable as a bony prominence for an extended period of time. This bony ridge later regresses as the bone develops. Rarely, a cephalhematoma becomes infected. This situation is potentially life-threatening.
A cephalhematoma often becomes apparent immediately after birth. Typical is initially a doughy-soft, later bulging-elastic, usually unilateral swelling on the head of the newborn. It most commonly develops on one of the two parietal bones (Os parietale), which forms the top and back of the bony skull.
The cephalhematoma has a hemispherical shape and sometimes reaches the size of a chicken egg. The periosteum is sensitive to pain. Therefore, newborns with a cephalhematoma may be more restless and cry more, especially when external pressure is applied to the cephalhematoma.
If a cephalhematoma does not regress or is very large, this is considered a possible indication of impaired blood clotting in the newborn. In some cases, neonatal jaundice (neonatal icterus) is exacerbated by the breakdown of the cephalhematoma.
What are the causes and risk factors of cephalhematoma?
Vessels located under the periosteum tear and begin to bleed. The periosteum is well supplied with blood, so the bleeding is sometimes relatively severe. If the space between the less extensible periosteum and the bone is filled (sign: prallelastic swelling), the bleeding stops.
Cephalhematoma: Risk factors
Risk factors for the development of a cephalhematoma are primarily considered to be suction cup birth and forceps delivery. However, a particularly rapid passage of the fetal head through the maternal pelvis or a very narrow birth canal also cause shear forces that sometimes lead to a cephalhematoma.
Another risk factor is the so-called occipital position or parietal leg position. In this case, the baby’s head does not lie forehead-first in the mother’s pelvic inlet, making it difficult to enter the birth canal.
How can you recognize a cephalhematoma?
If you have noticed the cephalhematoma yourself, your midwife or pediatrician are also your contacts. Possible questions in the introductory conversation (anamnesis) are, for example, the following:
- When did you notice the swelling?
- Has the swelling changed in size or texture?
- How did the birth of your child go? Were any aids such as a suction cup or forceps used?
- Is there any possibility of injury to the head after birth?
Cephalhematoma: Physical examination.
During the physical exam, the doctor will check to see if the sutures between the bones of the skull limit the swelling or if the swelling extends beyond them. The former would be a typical sign of cephalhematoma. He also checks the consistency of the swelling.
Rarely, a cephalhematoma overlies an injury to the skull bone. To rule this out, an ultrasound examination of the newborn’s head is usually performed.
Cephalhematoma: Similar diseases
For a definite diagnosis of “cephalhematoma,” your pediatrician must rule out other conditions. These include:
- Galea hematoma (bleeding under the scalp rind)
- Edema of the scalp (caput succedaneum, also called “birth swelling”), a buildup of fluid due to congestion of blood in the scalp during birth
- Encephalocele, leakage of brain tissue through the not yet closed skull due to a malformation
- Fall or other external violent impact
How can a cephalhematoma be treated?
Cephalhematoma usually does not require any special treatment. It regresses on its own within a few weeks. Puncture to aspirate the hematoma should be avoided: it poses a risk of infection to the newborn.
If there is an open wound of the scalp in addition to the cephalhematoma, a sterile dressing is required to prevent infection of the hematoma. For large hematomas, physicians monitor the concentration of bilirubin in the blood.
Newborns break down red blood cells at an increased rate immediately after birth. This produces bilirubin, which must be converted by the liver before the body excretes it. If the concentration of bilirubin is very high, it has a damaging effect on the newborn’s nervous system (kernicterus).
Sometimes in babies with a cephalhematoma, the bilirubin concentration increases more because the liver does not break it down fast enough. Special light therapy (blue light phototherapy) helps to lower the bilirubin concentration.