1、Cranial Complications in NewbornsDavid Kuykendall,MDUniversity of Nevada School of Medicine2013.Layers of Skull.CephalohematomaHemorrhage of blood vessels between the skull and periosteum of a newborn baby.Most commonly the bridging blood vessels crossing the periosteumBecause the bleed is limited t
2、o the subperiosteal plane,the bleed is limited to the particular bone of the craniumThis does not cross suture linesThis does not cross suture lines.CausesMost commonly caused by prolonged second stage of laborCommonly caused during assisted labor techniques such as vacuum-assisted vaginal deliverie
3、sMay also be common in labor dystocia from pressure of presenting part of the head through birthing canalCan be caused by forcep-assisted vaginal deliveries but less common compared to vacuum or labor dystocia.SymptomsJaundiceAnemiaHypotensionIrritabilityPoor Feeding.RisksCephalohematomas may take w
4、eeks to resolve as the baby slowly resorbs the blood clotMay mask an underlying linear skull fractureHigh risk for meningitis or osteomyelitisRule out subgaleal hemorrhageCoagulopathy?.Cephalohematoma.Subgaleal HemorrhageBleeding between the periosteum and the scalp galeal aponeurosisEtiology and si
5、gns similar to CephalohematomaCrosses suture lines!May present as hemorrhagic shock This area may hold up to 50%of the babys blood volumeCan present across entire scalp.CausesAlmost always caused solely by vacuum-assisted vaginal deliveriesIntense pressure required to create separation between apone
6、urosis and periosteumSteady traction during vaccum-assisted deliveries lowers risk.ManagementRule out CoagulopathyVigilant ObservationJaundice,Anemia,Neurological symptoms,Vital signsNEVER evacuate hematoma:high risk of infectionAbscess,meningitis,osteomyelitisPhototherapy if jaundicedSkull X-ray or
7、 CT to rule out fracturesOrder if neurological findings present on examMay take a couple of months to resolvePatient education:course,importance of observation,anticipatory guidance on signs of infection,jaundice,or hemorrhage.Subgaleal Hemorrhage.Caput SuccedaneumSerosanguinous,subcutaneous,and/or
8、periosteal fluid collection with poorly defined marginsBleeding below the scalp and above the periosteum.CauseSame as aboveMost commonly caused by pressure of presenting part of the cranium pushing against the dilating cervix during laborTourniquet effect.SignsSimilar to aboveScalp swelling that ext
9、ends over suture lines and associated with head moldingCommon finding is superficial bruising/edema due to tourniquet effect and superficial locationUnlike previous disorders,it usually is asymptomatic and does not present with symptoms other than scalp swelling.ManagementObservation,Observation,and
10、 more ObservationCommonly resolves within first weeks of lifeEducate parents that scalp shape should return to normalAnticipatory guidance on signs to return to ER:jaundice,anemia,neurological findings(change in activity or feeding)and signs of shock.Caput SuccedaneumNoImage.ReferencesAAP Textbook o
11、f PediatricsDamos JR,Bassett R.Chapter H:assisted vaginal delivery.In:Advanced Life Support in Obstetrics(ALSO)Provider Syllabus.4th ed.Leawood,Kan.Ronald S.Gibbs;David N.Danforth;Beth Y Karlan;Arthur F Haney(2008).Danforths obstetrics and gynecology.Lippincott Williams&Wilkins.p.470.Rosenberg A.Tra
12、umatic birth injury.NeoReviews 2003;4:270.UpToDate:Neonatal Birth Injuries.Retrieved 10-3-2013U.S.Food and Drug Administration,Center for Devices and Radiological Health.FDA public health advisory:need for CAUTION when using vacuum assisted delivery devices.Wen SW,Liu S,Kramer MS,et al.Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.
