CEPHALOHEMATOMA

Definition: A swelling of the scalp caused by a hemorrhage under the outer layer of bone in one area of the skull.

1. What caused this condition?

The swelling associated with this condition is a result of the scalp tissues being injured during the delivery process.

There are several types of swelling of the scalp that can occur, based on the depth of the swelling and/or the amount of bleeding involved. The different types of swelling are caput succedaneum, cephalohematoma, and subgaleal hematoma. Most types are more common with vaginal deliveries than cesarean sections.

Caput succedaneum: Superficial layers of the scalp with swelling and bruising that generally improves significantly prior to discharge from the hospital.

Cephalohematoma: Bleeding between the outer layer of the scalp bone and the lining of the bone. It is more contained and does not spread past the edge of the bone. It is often present along with caput succedaneum. When the superficial swelling goes away, it is more identifiable. The affected areas are soft and may be on one or both sides of the scalp. They may take several months to completely dissolve. As they go away, they may have a crunchy or crackly feeling to them.

Subgaleal hematoma: Bleeding that occurs deeper under the skin layers, but above the outer layer of the bones. This swelling can be seen all around the scalp and may push the ears forward slightly. Due to the amount of bleeding that can occur, it requires close monitoring and occasionally blood transfusions.

2. Is it potentially dangerous?

Cephalohematomas and subgaleal hemorrhages can be potentially dangerous depending on the amount of bleeding that occurs. Some cephalohematomas can also include fractures of the skull and bleeding inside the bones of the skull.

3. Does this condition represent any possible injury to the brain?

The majority of the time, there is no injury to the brain, as all the bleeding is small and outside of the skull. Rarely, when there is bleeding that occurs inside the skull, the brain may be at risk for injury.

4. What tests are needed to further define the condition?

The majority of the time, nothing needs to be done except a physical examination and observation. When there are concerns for larger amounts of bleeding, a blood count may be performed. In rare instances of concern for a skull fracture or bleeding on the inside of the skull, X rays of the skull and/or a CT scan of the skull and brain may be performed.

5. Are there any other potential problems that can occur in the future?

In the first week of life, the baby may have to be watched more closely for jaundice that needs treatment. The risk for significant jaundice increases with the amount of bleeding and the destruction of the red blood cells within the swollen area. If there are fractures of the skull, most do not need treatment. Also, bleeding inside the skull generally does not need surgery unless it is progressive and causes excessive pres- sure on the brain.

6. Over what period of time can we expect this condition to improve?

Caputs generally improve within several days. Cephalohematomas may take up to six months to resolve.

7. How often will you need to see my baby for follow-up after discharge from the hospital?

In most cases there is no needed special follow-up for this swelling. If there are concerns about jaundice, a daily blood test may be needed for several days after discharge from the hospital. In severe cases where there are skull fractures or bleeding inside the skull, follow up with a neurosurgeon (surgeon of the brain) may be necessary.