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Cephalohematoma

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Definition

Cephalhematoma can be defined as a medical condition, in which a hemorrhage occurs in newborn babies. The hemorrhage commonly takes place between the skull and the periosteum, being caused by the rupturing of blood vessels that are crossing the periosteum (membrane that covers the outer surface of the bones). The condition is associated with a subperiosteal inflammation, the further expansion being limited by the bones in the area (it cannot cross the suture lines).

This condition occurs in 1-2% of all the live births, being more often encountered in deliveries in which birth-assisting tools were used. This condition is not considered dangerous, with the exception of the situation in which neurological complications occur. However, it is important to understand that the condition on its own does not cause damage to the brain cells. The hemorrhage is located between the skull and the inner skin layers, so there is no connection to the brain. Male babies are more predisposed to developing cephalhematoma, in comparison to the female population. The hemorrhage can be unilateral or bilateral and it can resolve spontaneously, without any intervention being necessary. The bilateral involvement is encountered in 15% of all the cases.

Because the hemorrhage is a slow process, the condition is not obvious immediately after birth. In fact, it takes several hours after the birth, for the first symptoms to become apparent. If a skull fracture is associated with the cephalhematoma, it is possible that a bony protuberance is going to remain from the healing process. In the majority of the cases, the blood resulting from the hemorrhage is resorbed between the age of 2 weeks and 3 months.

What Causes Cephalohematoma?

These are the main causes that lead to the appearance of cephalhematoma:

  • Prolonged or difficult second stage of labor (from the time of complete dilation to the actual delivery of the baby)
  • Using certain instruments for the delivery (such as the ventouse or the forceps) – these instruments can cause trauma to the head, favoring the appearance of the cephalhematoma (small blood vessels in the periosteal region are broken, hence the hemorrhage)
  • Vitamin C deficiency – considered more of a risk factor than actual cause
  • Trauma to the birth
  • Head of the infant larger than the pelvic area of the mother
  • First pregnancy
  • Labor process – the head bangs against the pelvic bone during the labor
  • Large size of the baby (macrosomia) – the risk of cephalhematoma is higher in babies that are over the standard size
  • More common in the births with vaginal delivery (even though it has been encountered in C-sections as well)

Symptoms of Cephalohematoma

In the situation that the condition is severe, the primary symptoms include the yellow tinge of the skin (jaundice), anemia and reduced blood pressure. Often times, the cephalhematoma is an indication that a fracture has occurred at the level of the skull. The appearance of this hemorrhage also increases the risk for infection, with potential complications such as osteomyelitis or meningitis. The swelling cannot progress due to the suture lines, being confined to the surface of the respective bone. The swelling has firm boundaries, being the largest on the 2nd or 3rd day from the actual hemorrhage.

The hemorrhage that occurs at the level of the brain will take several weeks to resorb, with the inflammation subsiding in a gradual manner. It is possible that the area of the hemorrhage remain calcified, having however a softer center (in the medical literature, this is also known as a depressed fracture). Upon palpation, the respective areas feels fluctuant (due to the accumulation of blood). Unnatural bulges on the baby’s head might also be noticed. The bulge is soft, if there is only a small amount of blood coming from the said hemorrhage. On the other hand, if the hemorrhage was more extensive, the bulge is going to be felt firm to the touch.

Anemia and hyperbilirubinemia are considered to be complications of the cephalhematoma. Infection is also considered a complication – however, this often occurs if an attempt is made to drain the blood from the respective care (breech in the medical care).

Pictures

cephalohematoma

Cephalohematoma Picture 1 : Showing the Scalp, Periosteum, Hemorrhage and Cranium

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cephalohematoma picturesCephalohematoma Picture 2 (Top of Baby’s head) : Cephalhematoma, Galea aponeurotica, Scalp, Subgaleal hemorrhage, Skull and periosteum, Dura mater, Arachnoid membrane, Sudural hematoma and Epidural Hemorrhage

cephalohematoma pictures 2
Picture 3 (Coronal section of small child’s brain having Cephalohematoma between the Skull region and Periosteum) – Parts : Galeal aponeurosis, Periosteum (tough membrane covering bone), Blood, Sutural ligament, Scalp and Skull.

Diagnosis

The differential diagnosis can be made with the subgaleal hemorrhage. This is also known as the subaponeurotic hemorrhage, being a more extensive hemorrhage that occurs between the scalp and the bones of the skull (above the periosteum). There are more severe complications associated with this particular type of hemorrhage, including severe anemia and bruising.

Imaging studies, such as skull X-rays, CT scanning or MRI scans are recommended in patients who present neurological symptoms. The physical examination or observation can also be useful in making the diagnosis of cephalhematoma. No laboratory tests can be made in order to help with the diagnosis.

Treatment

There is no treatment for this condition. Usually, the patient is kept under observation. In patients who have developed jaundice (yellowing of the skin and the eye sclera), phototherapy is recommended. In the situation of severe anemia, blood transfusions are indicated. It is not recommended to aspirate or remove the blood that has accumulated due to the hemorrhage, due to the greater risk for infection (there is also the risk of abscess formation in the respective area). The blood will resorb on its own, taking even several months until it disappears completely.

As the hematoma resorbs, one will notice that the middle has disappeared firstly, with the outer rim becoming harder (due to the calcium). This is the normal evolution and one should not be worried about it. After a couple of months, X-rays or CT scans can be performed in order to see if the hemorrhage has resorbed completely and that there is no damage to the brain. Monitoring the baby is essential, especially if head trauma was associated with the cephalhematoma (risk of developmental delay).

Homeopathic treatment has also been proposed for the small patients diagnosed with cephalhematoma. Talk to the doctor before administering homeopathic treatment to your baby.


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