What Is a Newborn Cephalohematoma?
A newborn cephalohematoma — sometimes called a newborn hematoma or an infant hematoma — is a birth injury caused by trauma to an infant’s head.
According to experts from the University at Buffalo and the Thomas Jefferson University Hospital, “a cephalohematoma is an accumulation of blood under the scalp.”
In a hematoma, blood pools outside the blood vessels in the head. The pooled blood puts pressure on brain tissue. This leads to fatal complications or lifelong disability if not immediately diagnosed and treated.
Newborn cephalohematomas are relatively uncommon, and many cases heal on their own. However, in rare cases, severe infant hematomas can lead to complications and death if they are not treated immediately.
Quick Facts About Newborn Cephalohematomas
- Infant hematomas occur in 0.4% to 2.5% of all live births, according to experts from the University at Buffalo and the Thomas Jefferson University Hospital.
- Newborn cephalohematomas occur more in male infants and in large infants, and they usually develop hours or days after birth.
- With treatment, newborn cephalohematomas do not generally cause major problems to the newborn.
Types of Newborn Cephalohematomas
Newborn cephalohematomas are caused by injuries that occur during delivery, which cause blood to pool on top of a child’s brain, creating pressure on their brain tissue.
There are two categories of infant hematoma:
- Acute Infant Hematoma: With an acute infant hematoma, symptoms appear soon after the injury. Your child will start showing signs immediately or within hours of delivery.
- Chronic Infant Hematoma: With a chronic infant hematoma, your child might not start showing any symptoms for days or weeks after birth.
If acute infant hematoma is not treated properly, it can lead to chronic infant hematoma.
In a review of infant medical records, researchers from the Department of Neurosurgery at Kaohsiung Medical University Hospital found that over 60% of infants treated for acute hematomas had good results.
Diagnosing the condition early may improve the infant’s outcome. Without proper diagnosis and treatment, severe damage and even death may occur.
Cephalohematoma vs Caput Succedaneum
Unlike newborn cephalohematoma, which involves bleeding under the scalp, caput succedaneum describes swelling of a newborn’s scalp.
Caput succedaneum usually occurs because of pressure during a head-first delivery. It is more common in long or difficult deliveries and when vacuum extraction is needed.
Also unlike cephalohematoma, caput succedaneum usually needs no treatment, disappearing by the third day of life.
What Causes Newborn Cephalohematomas?
Head injuries that happen during birth cause infant hematomas.
Sometimes infant hematomas occur because the baby’s head was pushed against their mother’s pelvis. Other times, infant hematomas happen due to the use of forceps or a vacuum to aid the delivery.
Learn more about potential causes of newborn cephalohematomas.
Newborn cephalohematoma is usually a sign of difficult labor. The longer it takes to deliver a baby, the longer the baby’s head is being compressed by the birth canal.
If a fetus is large, infant cephalohematoma is more likely to occur. As with a long labor, this is because there may be 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.
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, which may cause infant cephalohematoma in some cases.
Doctors are trained to be able to detect and reduce the risks of newborn cephalohematoma. If a risk is identified, doctors should know what actions to take to help lessen potential injury, and they should monitor your baby for a hematoma after delivery.
If the doctor does not follow this protocol, and your child does not receive a quick medical intervention, it can be considered medical negligence. Misusing tools during delivery or failure to address the condition immediately can constitute medical malpractice.
Newborn Cephalohematoma Risk Factors
Not all of the causes listed above are guaranteed to give your child a hematoma. Your child can be pressed against your bones or delivered with forceps without causing an infant hematoma.
However, specific factors — called risk factors — lead to an increased risk of developing infant hematoma. The main reported risk factor for an infant hematoma is using vacuum extractors or forceps. Other risk factors include prolonged labor and premature birth.
Newborn hematoma risk factors include:
- Assisted-delivery devices used
- Carrying multiple children
- Fetus in a breech or posterior position
- Fetus is larger than normal
- Long labor
- Mother too weak to push the child through the birth canal
- Premature birth
If you had an assisted delivery where the doctor used forceps or a vacuum, the chance of your child having a severe cephalohematoma is much higher.
Possible Complications From a Newborn Cephalohematoma
Although newborn cephalohematomas aren’t always dangerous, they may lead to other complications that may prove harmful if they aren’t addressed and treated.
Anemia is a condition caused by a deficiency of red blood cells. Because newborn cephalohematoma causes pooling of blood, anemia can result from the blood loss.
If infant cephalohematoma does not go away after about one month, the hematoma may become calcified.
This 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 skull fracture. Although fractures occur in almost 25% of cases, they are usually not very serious.
One of the more dangerous complications of newborn cephalohematoma is infection.
Infection can begin in the pooled blood and lead to serious systemic infections such as sepsis or meningitis. Since these types of serious infections have a high death rate in infants, prompt diagnosis is critical.
Jaundice is caused when there is an excess of bilirubin, which is a chemical waste created by blood cells being recycled. Bilirubin is normally disposed of 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
Common signs of newborn cephalohematomas include soft spots (bulging fontanelles) on your child’s head, seizures, tiredness, and vomiting.
Other signs and symptoms to watch for include:
- Feeding difficulties
- High pitched cry
- Increased head circumference
Your child may develop signs and symptoms of a hematoma right after the injury occurred, or it may take days or weeks for symptoms to appear. This time between the injury and the appearance of symptoms is referred to as a lucid interval.
Additionally, sometimes bruising and hematomas can be 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 doctor suspects an infant hematoma, they 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. Most often, they will choose to do a computed tomography (CT) scan, but they may also recommend an X-ray or magnetic resonance imaging (MRI). The 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 an infant hematoma, seek immediate medical attention.
Your child may need surgery to drain the blood, remove a large clot, or tie off the bleeding vein. In cases where surgery is not needed, treatment involves a lot of rest.
Additionally, the complications caused by newborn cephalohematomas may need treating:
- Anemia: blood transfusion, phototherapy, or antibiotics
- Calcification: surgery
- Skull fracture: careful monitoring to ensure it heals properly
- Infection: antibiotics
- Jaundice: monitoring and light therapy in some cases
Speak with your doctor to learn their specific instructions for recovering from an infant hematoma.
Newborn Cephalohematoma Prognosis
Even for children who recover from a newborn cephalohematoma, there is a high chance they will experience further challenges. For instance, they might suffer from chronic headaches, attention problems, or anxiety.
Many of these complications can be avoided or reduced if the injury is caught and treated early. If your doctor or nurse fails to address the signs of an infant hematoma quickly enough, it can be considered medical negligence.
Financial Compensation for Infant Hematomas
Since infant hematomas can be the result of a birth injury, financial compensation may be available to you.
While this will not undo any harm caused to your child, the compensation can help you pay for your child’s ongoing treatment, as well as provide a sense of justice for a preventable act of medical negligence.