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Cranial Complications in Newborns

Cranial Complications in Newborns. David Kuykendall, MD University of Nevada School of Medicine 2013. Layers of Skull. Cephalohematoma. Hemorrhage of blood vessels between the skull and periosteum of a newborn baby. Most commonly the bridging blood vessels crossing the periosteum

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Cranial Complications in Newborns

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  1. Cranial Complications in Newborns David Kuykendall, MD University of Nevada School of Medicine 2013

  2. Layers of Skull

  3. Cephalohematoma • Hemorrhage of blood vessels between the skull and periosteum of a newborn baby. • Most commonly the bridging blood vessels crossing the periosteum • Because the bleed is limited to the subperiosteal plane, the bleed is limited to the particular bone of the cranium • This does not cross suture lines

  4. Causes • Most commonly caused by prolonged second stage of labor • Commonly caused during assisted labor techniques such as vacuum-assisted vaginal deliveries • May also be common in labor dystocia from pressure of presenting part of the head through birthing canal • Can be caused by forcep-assisted vaginal deliveries but less common compared to vacuum or labor dystocia

  5. Symptoms • Jaundice • Anemia • Hypotension • Irritability • Poor Feeding

  6. Risks • Cephalohematomas may take weeks to resolve as the baby slowly resorbs the blood clot • May mask an underlying linear skull fracture • High risk for meningitis or osteomyelitis • Rule out subgaleal hemorrhage • Coagulopathy?

  7. Cephalohematoma

  8. Subgaleal Hemorrhage • Bleeding between the periosteum and the scalp galealaponeurosis • Etiology and signs similar to Cephalohematoma • Crosses suture lines! • May present as hemorrhagic shock • This area may hold up to 50% of the baby’s blood volume • Can present across entire scalp

  9. Causes • Almost always caused solely by vacuum-assisted vaginal deliveries • Intense pressure required to create separation between aponeurosis and periosteum • Steady traction during vaccum-assisted deliveries lowers risk

  10. Management • Rule out Coagulopathy • Vigilant Observation • Jaundice, Anemia, Neurological symptoms, Vital signs • NEVER evacuate hematoma: high risk of infection • Abscess, meningitis, osteomyelitis • Phototherapy if jaundiced • Skull X-ray or CT to rule out fractures • Order if neurological findings present on exam • May take a couple of months to resolve • Patient education: course, importance of observation, anticipatory guidance on signs of infection, jaundice, or hemorrhage

  11. Subgaleal Hemorrhage

  12. Caput Succedaneum • Serosanguinous, subcutaneous, and/or periosteal fluid collection with poorly defined margins • Bleeding below the scalp and above the periosteum

  13. Cause • Same as above • Most commonly caused by pressure of presenting part of the cranium pushing against the dilating cervix during labor • Tourniquet effect

  14. Signs • Similar to above • Scalp swelling that extends over suture lines and associated with head molding • Common finding is superficial bruising/edema due to tourniquet effect and superficial location • Unlike previous disorders, it usually is asymptomatic and does not present with symptoms other than scalp swelling

  15. Management • Observation, Observation, and more Observation • Commonly resolves within first weeks of life • Educate parents that scalp shape should return to normal • Anticipatory guidance on signs to return to ER: jaundice, anemia, neurological findings (change in activity or feeding) and signs of shock

  16. Caput Succedaneum

  17. References • AAP Textbook of Pediatrics • Damos 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). Danforth's obstetrics and gynecology. Lippincott Williams & Wilkins. p. 470. • Rosenberg A. Traumatic birth injury. NeoReviews 2003; 4:270. • UpToDate: Neonatal Birth Injuries. Retrieved 10-3-2013 • U.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.

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