Newborn cephalohematoma is a birth injury caused by trauma or pressure to the head during labor or childbirth. A pool of blood collects underneath the scalp and outside the skull. This happens because of ruptured or damaged, small blood vessels in the scalp. Since the blood build-up is on top of the skull, the baby’s brain is not at risk of pressure or bleeding because it’s beneath the skull bones. Therefore, infant cephalohematoma doesn’t pose any danger to the baby’s brain.
The bleeding is slow, and it may take hours or days following the birth for the cephalohematoma to form. Cephalohematoma is one of the most common birth injuries affecting between 1% and 2% of all babies during and after birth.
While most newborn cephalohematoma usually resolves on its own without intervention, your doctor may refer you to a specialist for further evaluation.
Symptoms of Cephalohematoma
The most common symptom is a soft bulge or a bump at the back or top of your baby’s head. Generally, there will be no bruising, cuts, or reddening on the skin over the bulge.
Cephalohematoma varies in size and can be noticeable or less obvious. At first, the bump feels soft, but as the pooled blood begins to calcify, it feels harder and denser. After several weeks the bulge starts shrinking, and in most cases, the center part of the bump dissolves before the outer edges creating a "crater-like" look. It is a sign that the process of healing is going well. Besides the bulge, newborn cephalohematoma may cause internal symptoms.
These symptoms include:
- Infection: This is a harmful complication that may occur in some cases of infant cephalohematoma.
- Jaundice: In rare cases, cephalohematoma may increase the baby’s risk of developing newborn jaundice due to the excessive bilirubin levels in the blood.
- Anemia: Low levels of red blood cells is another common symptom.
Diagnosis of Cephalohematoma
Usually, your doctor will carry out a full-body physical inspection on your newborn after delivery and at your first pediatrician's visit 1-3 days later.
A bulge alone may be enough for the diagnosis, but in some cases, your doctor may request additional tests, including:
- CT scan
- MRI scan
Causes of Cephalohematoma
Newborn cephalohematoma usually occurs during the labor or delivery process. However, it may take many hours or days after birth before it forms. Intense pressure or trauma on the infant’s head during delivery or labor may cause the delicate blood vessels on the scalp to tear, causing a cephalohematoma. The exact cause of head trauma during delivery which causes cephalohematoma can vary.
One common cause is when a baby's head hits the mothers' pelvic bone as it goes through the birth canal. When this happens, the force from the contractions continues pushing the head until it finds its way through the birth canal.
These medical devices come in handy when the mothers’ uterine contractions are not enough to push the baby through the birth canal. Doctors in the delivery room use these devices to grip the baby’s head, and they can cause enough force to rupture the blood vessels on the baby’s head.
Risk Factors for Newborn Cephalohematoma
Any infant delivered vaginally could develop cephalohematoma. However, several factors may increase the risk. The common risk factors include:
- Use of birth assisting tools such as forceps and vacuum extractors
- Prolonged labor due to weak uterine contractions, an infant with a head that’s larger than the mother’s pelvic area, and a baby that’s larger than its expected gestational age
- Multiple gestations births
- An abnormal position could make the childbirth process longer and more complicated.
- If an infant’s head hit the mother’s pelvic bone during labor
Treatment of Cephalohematoma
In most instances, your newborn will not need any treatment for cephalohematoma because it goes away without any medical interventions. The bump goes away after several weeks or months. Occasionally a doctor may attempt to drain it, though this is not always necessary. Your doctor will advise you to monitor the area carefully for any unusual symptoms.
Most babies don't suffer any long-term complications or delay development due to the injury. However, on some occasions, cephalohematoma may cause other health problems, such as:
- Skull fracture
- Calcification may happen, causing bone deposits to collect around the blood pool
Although rare, if a newborn cephalohematoma gets infected, your doctor may perform drainage and put your infant under antibiotic treatment. Newborn jaundice requires close monitoring and treatment. If a baby develops anemia, a blood transfusion may be necessary.