What is Cephalohematoma?
A cephalohematoma is a pool of blood that gathers beneath the outermost layer of a baby’s skull, usually in the back or side regions of the head. This often happens during childbirth when friction between the skull and scalp causes the outer layer to separate from the skull itself, breaking blood vessels. As this bleeding happens gradually, a cephalohematoma is usually not apparent immediately after birth.
Instead, it develops in the hours or days following birth, most commonly appearing within the first one to three days. Because the cephalohematoma is deep within the outer layer of the skull, its boundaries are defined by the shape of the underlying skull. It is important to know that a cephalohematoma is contained – it doesn’t cross the middle of the skull or the lines where the skull bones meet.
What Causes Cephalohematoma?
Cephalohematoma is when blood vessels in the baby’s head get damaged due to pressure during birth. This pressure can be from the baby’s head passing through the narrow birth canal or from using tools like forceps or a vacuum extractor to help with the delivery. This causes the small and sensitive blood vessels to burst, leading to a pool of blood under the skin of the baby’s head.
Certain things can increase the pressure on the baby’s head, making it more likely for a newborn to develop a cephalohematoma. These include:
* The second stage of labor going on for a long time
* A baby being unusually large compared to the size of the birth canal
* The mother’s contractions being weak or not effective
* The baby not being positioned normally
* Using tools like forceps or a vacuum to assist in the delivery
* Having more than one baby in the pregnancy
It’s also more likely if the back of the baby’s head is sideways or backwards during delivery, or if a C-section is started after the first stage of labor, or if the baby has a blood clotting disorder.
These risk factors all add to the strain of the birth process on the baby’s head. Cephalohematoma doesn’t usually happen in adults or older children, but it might occur after an injury or surgery.
Risk Factors and Frequency for Cephalohematoma
Cephalohematoma is a condition that happens in 0.4% to 2.5% of all babies born alive. We aren’t sure why, but it’s seen more often in boys than girls.
The chances of a cephalohematoma occurring are lowest in babies born through normal vaginal deliveries, affecting 1.67% of these births. First-time mothers, babies who are larger than average, and babies in specific positions at the start of labor are more prone to this condition. Additionally, it’s more common in births where tools like forceps or vacuum extractors were used.
- Of these instrument-assisted deliveries, cephalohematomas are most common after a vacuum-assisted delivery, occurring in 11.17% of those cases.
- The rate of occurrence for forceps-assisted and caesarean deliveries is 6.35%.
- Interestingly, when a cesarean section is performed before a woman goes into labor on her own, cephalohematomas are not typically seen.
Signs and Symptoms of Cephalohematoma
A newborn baby is at risk of developing a condition called cephalohematoma if the birthing process involved certain risk factors. The specific factors include having a long second stage of labor, abnormal fetal presentation, a large baby size (macrosomia), and deliveries involving operative or surgical methods. These factors can increase pressure on the baby’s head, which may lead to a cephalohematoma.
A cephalohematoma is not typically noticeable at birth because it results from slow bleeding beneath the periosteum (a covering layer of the skull). Instead, the symptoms often become noticeable within 1 to 3 days after birth. To identify this condition, healthcare providers perform repeated inspections and palpations (touch examinations) of the newborn’s head. If a cephalohematoma is identified, it’s crucial to keep track of its appearance and size.
When a baby has a cephalohematoma, they may show a firm and swollen area on their head that gradually becomes more fluctuant (or less firm). The scalp over the swollen area typically shifts easily when touched. Physically, cephalohematomas are characterized by bulged areas on one or both sides of certain bones underneath the scalp, with the swelling being non-translucent and the skin above typically remaining normal in color and undamaged. The edges of the cephalohematoma follow the lines of the areas where the cranial bones join (known as sutures). The parietal region (towards the top and back of the head) or occipital region (at the back of the head) is the most common site of injury. However, a cephalohematoma can occur over any of the cranial bones.
Testing for Cephalohematoma
Cephalohematoma, a condition where a baby is born with a noticeable bump on their head, is typically diagnosed by clinicians. The bump doesn’t cross the skull’s natural divisions, known as cranial suture lines. Initially, the bump may feel firm, but it becomes softer over time. Unlike other conditions, cephalohematoma usually emerges about 1-3 days after the baby is born, rather than immediately after birth.
To support their diagnosis, healthcare providers might order additional tests, such as skull x-rays, CT scans of the head, or ultrasound scans. These might be particularly useful if there is a concern of a skull fracture underneath the bump. Both CT scans and ultrasound can be used to check for any bleeding inside the skull and to give a more detailed understanding of where exactly the bleeding is located outside the skull.
If a baby develops cephalohematoma, they might need to be checked for conditions that lead to excessive bleeding, like von Willebrand disease. However, doctors usually avoid using a needle to drain the bump due to the risk of introducing an infection. If there’s suspicion of an infection, draining might be considered. The primary type of bacteria linked to infected cephalohematoma is Escherichia coli.
Treatment Options for Cephalohematoma
The treatment for cephalohematoma, a collection of blood under the skin of a newborn’s skull, generally involves careful monitoring. The lump from this condition may take weeks to shrink as the body slowly absorbs the clotted blood. It can turn hard when the blood solidifies, and then starts to be reabsorbed. Oftentimes, the center of the lump disappears before the sides, giving the appearance of a crater. This is a typical healing process for the condition.
Draining the lump is usually not attempted unless an infection is suspected. This is because the blood has often clotted and it’s difficult to remove. Moreover, piercing the lump can raise the possibility of encountering infection or forming an abscess. The most favorable treatment is simply observing and allowing the body time to reabsorb the fluid.
Generally, this condition doesn’t pose significant issues for newborns. Yet, there might be a higher risk of baby jaundice in the few days after birth. Thus, it’s essential to closely watch for signs like yellowish discoloration of the skin, eyes, or mucus membranes. If needed, a meter measuring the levels of a substance called bilirubin can assist in assessing the baby. If signs of jaundice are noticed, a blood test to measure bilirubin levels should be performed.
In rare cases where the lump doesn’t decrease, it may solidify or calcify. If the lump hasn’t shrunk within six weeks of birth, a skull x-ray or a head CT scan might be needed. An ossified cephalohematoma becomes hard and shows defined outer and inner layers of bone around the area. If the contour of the inner layer follows the convex shape of the skull, it can intrude upon the brain cavity.
There’s a debate on whether to simply observe or to intervene surgically early on for cephalohematoma. Some believe early surgery isn’t needed unless the lump is very large or causes other health issues. Advocates for surgery argue it is better to intervene early because the baby’s skull naturally reshapes over time, reducing the risk of pressure buildup inside the skull and improving appearance.
Surgery is rarely suggested for cosmetic reasons for an ossefied cephalohematoma. However, surgery can treat this condition effectively if needed, through procedures like a craniotomy, craniectomy, or cranioplasty. The surgery entails removing newly formed bone, the soft tissue mass, and the original underlying bone. After this, the affected region is often reshaped by dividing it into several parts and forming a bone graft. Many techniques for this surgery provide satisfactory results with little or no noticeable evidence in subsequent years.
What else can Cephalohematoma be?
When doctors are trying to diagnose a cephalohematoma, which is a blood collection between the skin and the skull in a newborn, they need to think about other conditions that could cause similar symptoms. Being accurate in the diagnosis matters a lot because it affects how the baby will be treated.
Two other conditions to consider are:
Caput Succedaneum: This is when there’s swelling of a baby’s scalp. It occurs just under the skin, but above a tissue layer of the head called the epicranial aponeurosis. This swelling often doesn’t have a well-defined shape, can span across the joints between skull bones, and is usually present when the baby is born. Unlike a cephalohematoma, caput succedaneum typically goes away within a few days after birth.
Subgaleal Hematoma: This happens when there is a bleeding underneath the protective tissue layer of the head, and above the outer layer of the skull. This condition can occur right after birth or a few hours later. In severe cases, it can pose a life-threatening condition due to the risk of excessive blood loss. It can also cover larger areas of the skull, as it’s able to cross the joints between skull bones – this is different to cephalohematoma.
What to expect with Cephalohematoma
In most instances (around 80%), a condition known as cephalohematoma clears up within the first month of a baby’s life. It’s important to note that children usually don’t suffer any related brain issues since the cephalohematoma forms on the surface of the skull without touching the actual brain tissue.
In some rare cases, cephalohematomas may harden or cause changes in appearance, but these situations are uncommon. Even when they do occur, they typically don’t lead to lasting negative impacts on the baby’s health.
Possible Complications When Diagnosed with Cephalohematoma
Some uncommon but potential complications that can occur with cephalohematoma include a drop in red blood cell count (anemia), infection, yellowing of the skin and eyes (jaundice), low blood pressure (hypotension), bleeding within the skull (intracranial hemorrhage), and breaks in the bone that lie underneath (linear skull fractures) seen in 5% to 20% of cases. In some rare cases, cephalohematomas may harden (calcify) or lead to appearance changes (cosmetic deformities).
Here is a list of the rare complications:
- Low red blood cell count (anemia)
- Infection
- Yellowing of the skin and eyes (jaundice)
- Low blood pressure (hypotension)
- Bleeding within the skull (intracranial hemorrhage)
- Breaks in the bone (linear skull fractures), seen in 5% to 20% of cases
- Hardening of the area (calcification)
- Changes to appearance (cosmetic deformities)
Preventing Cephalohematoma
Helping prevent cephalohematoma, a swelling on a newborn’s head caused by bleeding under the skin, is key, and starts with fully teaching parents what to look out for. Expectant parents should understand the risks that could increase the chances of cephalohematoma, like a long labor period or using tools for delivery like forceps or vacuum extractors. Sharing facts about how cephalohematoma usually disappears on its own would comfort parents and stop them from seeking unnecessary medical treatments.
Doctors should stress the need for constant check-ups for symptoms of complications like anemia or jaundice, and ask parents to report any worries immediately. Usually, newborns who have cephalohematoma but no other issues are sent home with their families. Parents need to watch the bump on the baby’s head for any changes, such as getting bigger in the first week after being born. Parents must also keep an eye on any changes in the baby’s behavior such as getting sleepier, crying more, changing the way they cry, not wanting to feed, and other signs that the baby might be in pain or have a new problem.
There’s not much to do to help heal a cephalohematoma other than keep watching it. By educating caregivers on how to spot signs of infection and stressing the need to keep the affected area clean, potential complications can be avoided.
