What Is a Newborn Cephalohematoma?
Newborn cephalohematoma is a buildup of ruptured blood vessels in the periosteum, which is the tissue that covers the skull.
In a hematoma, blood pools outside the blood vessels and is visible on the baby’s scalp. The pooled blood puts pressure on brain tissue, which may lead to fatal complications or lifelong disability if not immediately diagnosed and treated.
This type of birth injury is relatively uncommon, and many cases will heal on their own. In rare cases, however, severe infant hematomas can lead to complications or death if they are not treated immediately.
According to experts from the University at Buffalo and the Thomas Jefferson University Hospital, infant hematomas occur in 0.4% to 2.5% of all live births.
Types of Newborn Cephalohematomas
There are two categories of infant hematoma:
- Acute Infant Hematoma: Symptoms will appear immediately or within hours of delivery
- Chronic Infant Hematoma: Symptoms may not appear until days or weeks after birth
If acute infant hematoma is not treated properly, it can lead to chronic infant hematoma.
According to researchers from the Department of Neurosurgery at Kaohsiung Medical University Hospital, over 60% of infants treated for acute hematomas had positive results. Diagnosing the condition early on may improve the outcome of the hematoma. Without proper diagnosis and treatment, severe damage or even death may occur.
Cephalohematoma vs Caput Succedaneum
Unlike newborn cephalohematoma, which involves ruptured blood vessels under the scalp, caput succedaneum is classified as swelling of the scalp itself.
Caput succedaneum usually occurs from the pressure during a head-first delivery. It is more common in long or difficult deliveries and/or when vacuum extraction is needed. Unlike newborn cephalohematoma, caput succedaneum usually requires no treatment and disappears by the third day of life.
What Causes Newborn Cephalohematomas?
Head injuries that take place during childbirth cause newborn hematomas. These injuries may occur because the baby’s head was pushed against their mother’s pelvis. Other times, newborn hematomas happen due to the use of forceps or vacuum extraction complications.
Overall, newborn cephalohematoma is usually a sign of a difficult labor. The longer it takes to deliver a baby, the longer the baby’s head may be compressed by the birth canal, increasing the risk of a newborn hematoma.
Infant hematomas may also occur due to infant size, assisted-delivery devices, and medical negligence.
If a fetus is large, newborn cephalohematoma is more likely to occur. As with a long labor, this may occur from increased stress and compression on the baby in the birth canal. Additionally, average-sized fetuses can experience increased compression if the mother has a smaller than normal pelvis.
Newborn cephalohematomas occur more in male infants and in large infants.
Doctors sometimes decide to use devices such as forceps or a vacuum to aid in deliveries that are longer or more difficult than usual. These tools may put more pressure on the baby’s head, increasing the risk of newborn cephalohematoma.
Doctors are trained to detect and reduce the risks of newborn cephalohematoma. If a risk is identified, doctors should take actions to decrease the chances of a potential injury and monitor your baby for a hematoma after delivery.
If the doctor does not follow protocol and your child does not receive prompt medical intervention, it may be considered medical negligence. Misusing tools during delivery or failure to address fetal distress immediately can constitute as medical malpractice.
In cases of medical practice, compensation may be available to you and your family.
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Newborn Cephalohematoma Risk Factors
Not all of the causes listed above are guaranteed to give your child a hematoma. However, there are risk factors that can increase the risk of developing newborn cephalohematoma. The most common reported risk factor for an infant hematoma is using vacuum extractors or forceps during childbirth.
Newborn hematoma risk factors include:
- Carrying multiple children
- Difficult or prolonged labor
- Fetus in a breech or posterior position
- Fetus is larger than average
- Mother is unable to push the child through the birth canal
- Premature birth
- Use of assisted-delivery devices such as forceps or vacuum extractor
Possible Complications From a Newborn Cephalohematoma
Anemia is a condition caused by a deficiency of red blood cells. Since newborn cephalohematoma causes pooling of blood, anemia can result from the blood loss.
If newborn cephalohematoma does not go away after about one month, the hematoma may become calcified. Calcification is when bone deposits form and harden around the pool of blood. While it is uncommon, cephalohematoma calcification can cause serious deformity to the skull.
Fracturing of the Skull
A more common complication of newborn cephalohematoma is fractures to the skull. Although fractures occur in almost 25% of cases, they are usually not very serious and often heal without significant medical intervention.
One of the more dangerous complications of newborn cephalohematoma is infection.
Infection can begin in the pooled blood and lead to a serious systemic infection such as sepsis or meningitis. These types of serious infections have a high death rate in infants, so getting diagnosed promptly is critical.
Jaundice is caused when there is an excess of bilirubin, which is a chemical waste created by recycled blood cells. Bilirubin is normally disposed through the liver and urination. Babies with jaundice usually have a yellowish color in their skin and eyes.
Untreated jaundice can cause kernicterus, which is a serious condition that can cause brain damage and even lead to death.
Newborn Cephalohematoma Symptoms
- Feeding difficulties
- High pitched cry
- Increased head circumference
- Pain in the skull area
- Soft spots (bulging fontanelles) on the head
Your child may develop signs and symptoms of an infant hematoma right after the injury occurred, or it may take days or weeks for symptoms to appear. The time between the injury and the appearance of symptoms is referred to as the lucid interval.
Additionally, bruising and hematomas are commonly mistaken for one another. The collection of blood in a hematoma can create a dark spot on your baby’s skin, similar to a bruise. While bruises typically appear a few hours after a child sustains a minor injury, cephalohematomas occur exclusively after head trauma.
Diagnosing Newborn Cephalohematoma
If your child is exhibiting symptoms of newborn cephalohematoma, your doctor will monitor your child’s head size to see if it is expanding more rapidly than it should.
Your doctor will also check your child’s hematocrit level — the number of red blood cells compared to the rest of their blood’s volume — to see if it is lower than it should be.
Next, your doctor will likely order imaging scans. They will often choose to conduct a computed tomography (CT) scan, and they may also recommend an X-ray or magnetic resonance imaging (MRI). These imaging tests will help the doctor pinpoint the source of the bleeding and the size of the hematoma.
Newborn Cephalohematoma Treatment
If you suspect your child has a newborn hematoma, seek immediate medical attention. Your child may need surgery to drain blood, remove a large clot, or tie off a bleeding vein. In cases where surgery is not needed, treatment involves a lot of resting.
Treatments for possible complications caused by a hematoma include:
- Anemia: Blood transfusion, phototherapy, or antibiotics
- Calcification: Surgery
- Skull fracture: Careful monitoring to ensure it heals properly
- Infection: Antibiotics
- Jaundice: Monitoring and light therapy
With treatment, a hematoma does not generally cause major problems to the newborn. Speak with your doctor to learn their specific instructions for recovering from newborn cephalohematoma.
Newborn Cephalohematoma Prognosis
With prompt and proper treatment, children diagnosed with newborn cephalohematoma are likely to live a life without any physical or developmental challenges and live as long as an individual without the condition would live.
Many of the complications related to newborn cephalohematomas can be avoided or reduced if the injury is caught and treated early. For this reason, if your doctor or nurse fails to address the signs of an infant hematoma quickly enough, it can be considered medical negligence.
Do you suspect your child’s birth injury was caused by medical malpractice?
Financial Compensation for Newborn Cephalohematoma
If your child suffered a preventable birth injury, you and your family may be entitled to financial compensation. Although pursuing legal action will not undo any harm caused to your child, the compensation can help you pay for your child’s ongoing treatment and provide a sense of justice for the act of medical negligence.
If you would like to connect with a law firm experienced in birth injury cases, contact the Birth Injury Justice Center today to get a free case review.