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Cephalohematoma

Michael Becker

Cephalohematoma is the medical term for a collection of blood under the periosteum of the skull bones. It is a type of bleed or hemorrhage. It can occur in people of all ages. Cephalohematoma sometimes occurs in newborn infants due to a traumatic rupture of blood vessels.

Cephalohematoma Risks

The risk of cephalohematoma is higher when

  • Assistive devices are used during the delivery
  • Labor is prolonged and difficult
  • The baby’s head is larger than the mother’s pelvic outlet

It is more common in first pregnancies. Doctors consider it a self-healing minor injury, but in some infants, it can lead to further medical complications. Importantly, cephalohematoma can be an indication of birth trauma which may have caused other injuries to the baby’s brain.

Cephalohematoma Symptoms

There are no obvious symptoms of cephalohematoma other than a visible deformation of the infant’s skull. It feels like a squishy water balloon. The baby behaves normally. Parents should be vigilant for any unnatural bulging of the infant’s head. Other signs and symptoms of the condition include anemia and jaundice.

Cephalohematoma Treatment and Management

A doctor must examine a baby with suspected cephalohematoma. In the majority of cases, the cephalohematoma heals on its own without specific treatment. However, in some babies the following therapies may be necessary:

  • Drainage of the hematoma may be recommended, but this is rare as it increases the chances of abscess formation and infection.
  • Large cephalohematomas may cause the baby’s hemoglobin level to drop, necessitating a blood transfusion.
  • Babies with cephalohematoma have an increased risk of jaundice due to high bilirubin levels from the breakdown of blood. Such infants may require treatment of jaundice with phototherapy.

Cephalohematoma Ultrasound

A cephalohematoma can be imaged with ultrasound, MRI, or CT.

Cephalohematoma Complications

In addition to discomfort, cephalohematoma can be associated with the following complications:

  • Damage to adjacent blood vessels
  • Infection
  • Jaundice
  • Excessive bleeding
  • Nerve damage
  • Excessive pressure in the cranium

Cephalohematoma Healing Time

How long does cephalohematoma last? Typically, it goes away in a few weeks to months.

Enlarging Cephalohematoma

A growing cephalohematoma can be very concerning for parents. A newborn infant’s cephalohematoma may get bigger in the few days following birth. However, parents must seek medical attention if the baby has an enlarging, red, fluctuant bulge on the head which does not show any signs of becoming smaller. This could indicate an infection.

Calcified Cephalohematoma

The middle portion of a cephalohematoma often disappears first and the perimeter becomes calcified, giving the bump a crater-like appearance. This is called a calcified cephalohematoma. It is a normal sign that indicates the hematoma is resolving. Calcified hematomas may persist for a few years.

Cephalohematoma versus Subgaleal Hematoma

A subgaleal hemorrhage is a bleed that is above the periosteum of the skull bones. It refers to a pooling of blood under the galea aponeurotica of the scalp. In some of the cases, it is caused by the inappropriate application of vacuum to the baby’s head during delivery.  If severe, subgaleal may cause hypovolemic shock and brain damage.

Cephalohematoma versus Caput Succedaneum

Caput succedaneum refers to a fluid collection under the scalp. Cephalohematoma is a pooling of blood. Moreover, since a cephalohematoma is under the periosteum, it cannot cross cranial lines, i.e., it is limited to the boundaries of the bone.

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