Cephalhematoma

Cephalhematoma: description

The word cephalhematom describes a collection of blood in the head of a newborn. “Kephal” comes from the Greek and means “belonging to the head”. As hematoma physicians refer to a bruise or a compact accumulation of blood in the tissue. The cephalic hematoma is formed in the natural birth by tearing small blood vessels between the outer cranial bone and its periosteum, when the child’s head in the birth canal is exposed to large tangential forces (shear forces).

The skull construction in newborns

The skull of the newborn is still soft and deformable. Outside sits the so-called Kopfschwarte. These include the scalp with its hair and subcutaneous fatty tissue, as well as the hood-like muscle-tendon plate (Galea aponeurotica). Below is the skull bone, which consists of several parts that are not yet firmly grown together in the newborn. The skull bones on its inside and outside the so-called periosteum, which protects and nourishes the bone.

The cephalhematoma forms on the outside between the periosteum and the bone. It is bounded by the edges of the skull bone. This makes it easy to distinguish from another typical neoplasmic head swelling, the so-called birth tumor, a doughy-soft swelling under the scalp that exceeds the limits of the individual skull bones.

Cephalhematoma: Occurrence

According to medical literature, in one to two births of 100, a cephalhematoma occurs. It is possible that at the same time the skull bone is incompletely broken (broken), it is called the “infraction”.

Above all, forceps deliveries or suction-augmentations (vacuum extractions) are associated with the development of a cephalhematoma. Here, either so-called tongs or a suction cup attached to the child’s head, thus facilitating the birth.

Cephalhematoma: symptoms

A cephalhemoma often manifests itself immediately after birth as a soft-dough, later as increasingly bulging-elastic and usually only one-sided existing swelling on the head of the newborn. It is most commonly produced on one of the two parietal bones, which form the top and back of the bony skull.

The cephalhematoma has a hemispherical shape and can grow to the size of a hen’s egg. Since the periosteum is particularly sensitive to pain, the newborn can be more restless and cry more, especially when external pressure is applied to the cephalhematoma. In large or (rarely!) Multiple cephalic hematomas, the blood loss from the newborn’s circulation may be so great that anemia (anemia) or volume depletion up to circulatory shock occurs.

If a cephalhematoma does not return or is very large, this may be an indication of a disturbed blood clotting of the newborn.

Cephalhematoma: causes and risk factors

The reason for the development of a cephalhematoma are shear forces acting on the neonatal head in the narrowness of the birth canal. Through these forces, the soft parts of the head move and the periosteum can be sheared off the bone. Under the periosteum located vessels tear it in and start to bleed. Since the periosteum is well supplied with blood, the bleeding can be relatively strong. If the space between the low-stretched periosteum and the bone is filled (signs: bumpy swelling), the bleeding comes to a standstill.

Cephalhematoma: risk factors

As a risk factors for the emergence of a cephalic hematoma apply especially the Saugglockengeburt and the forceps birth. But even a particularly rapid passage of the child’s head through the maternal pelvis or a very narrow birth canal can cause similar shear forces and thus lead to a cephalhematoma. Another risk factor is the so-called occipital or crest position. The child’s head is not downright forehead in the pelvic entrance of the mother, so that entry into the birth canal can be difficult.

Cephalhematoma: examinations and diagnosis

Often the cephalhematoma is already discovered by the midwife or the pediatrician shortly after birth. It may be that the hematoma is initially superimposed by the very frequent so-called birth swelling on the head of the newborn and only after their decline after a few days notice. Midwife or pediatrician are your contact persons. Questions from the doctor at the introductory interview (anamnesis) could be:

• When did you notice the swelling?
• Has the swelling changed in size or texture?
• How did your child’s birth go? Were aids such as a suction cup or forceps used?
• Is injury to the head possible after birth?

Cephalhematoma: physical examination

During the examination, the doctor checks whether the tumor is limited or exceeds the size of the sutures between the skull bones. The former would be a typical sign of the cephalhematoma. He also checks the consistency of the swelling. He then examines your child for any neurological (nervous system related) abnormalities. Among other things, it lights up in the eyes of your child (examination of the pupil-light reaction) and checks whether your child, for example, responds to acoustic stimuli (sounds).

Cephalhematom: similar diseases

For the diagnosis of “cephalhematoma” your pediatrician must rule out other diseases. This includes:

• Galeahämatom (bleeding under the head rind)
• Edema of the head rind (caput succedaneum, also called “birth swelling”), an accumulation of fluid due to congestion in the scalp during childbirth
• Encephalocele, the leakage of brain tissue through the still-occluded skull due to a malformation
• Fall or other external violence

Cephalhematoma: treatment

The cephalhematoma usually requires no special treatment. It recovers itself within a few weeks. In particular, a puncture to aspirate the hematoma should be omitted, as it represents a risk of infection for the newborn. In the worst case, then a collection of pus (abscess) could form, which can be life-threatening.

The only therapy by the doctor with the cephalhematoma is to give the newborn a precautionary vitamin K. Vitamin K is needed by the body to produce important proteins in the liver, which are important for blood clotting (coagulation factors). Because of the still existing vascular injury, functioning coagulation is important to prevent further growth of the cephalic hematoma.

If, in addition to the cephalhematoma, an open wound of the scalp is present, a sterile dressing is required to prevent infection of the hematoma. For large hematomas, the concentration of bilirubin in the blood should be monitored. Newborns reduce red blood cells immediately after birth. This causes bilirubin, which must be converted by the liver so that the body can excrete it. It could otherwise damage the nervous system of the newborn in a high concentration (kernicterus). The simultaneous degeneration of the cephalhematoma can overtax the liver and the bilirubin concentration increases even further. A special light therapy (blue light phototherapy) can lower the bilirubin concentration.

Cephalhematoma: disease course and prognosis

Overall, the prognosis for the cephalhematoma is very good. In the first days after birth, it often increases in size and changes in texture, because the initially clotted blood of the hematoma liquefies again in the degradation process. Within a few weeks to months, however, the hematoma disappears. Sometimes, however, it may calcify along its edges along the cranial sutures and remain tactile for a long time as a bony prominence. This bony wall is formed later in the course of bone development. In rare cases, one can Cephalhematoma infect. This situation can be life threatening.