Why does it occur
During childbirth, the baby's head experiences pressure and changes shape to adapt to the birth canal. The skin and subcutaneous tissues are displaced relative to the bones of the skull, and small vessels running in the periosteum may rupture. Blood accumulates under the periosteum, which is tightly adhered to the edges of the bone, so the formation never extends beyond the boundaries of one bone. The likelihood is higher with a large fetus, a protracted or, conversely, rapid course of labor, a narrow maternal pelvis, and also when using a vacuum extractor or obstetric forceps. This is not a consequence of errors in care or the result of trauma after childbirth.
- Displacement of head tissue relative to bone during childbirth
- Rupture of periosteal vessels
- Large fetus and discrepancy in pelvic size
- Prolonged or rapid labor
- Vacuum extraction and obstetric forceps
- Most often on the parietal bone, less often on the occipital bone
How is it different from a birth tumor?
A birth tumor is swelling of the soft tissues of the presenting part of the head, which is noticeable immediately after birth, has a pasty consistency, freely passes through the sutures of the skull and disappears in 1–3 days. Cephalohematoma often becomes noticeable not in the first hours, but on the second or third day; it is felt as an elastic formation with clear boundaries and never spreads to the adjacent bone. The skin above it is of normal color. There are also more rare conditions, for example, extensive subgaleal hemorrhage, which spreads throughout the head and is dangerous for significant blood loss, so a doctor’s examination is required.
- Birth tumor: immediately after birth, goes away in 1–3 days
- The birth tumor passes through the sutures of the skull
- Cephalohematoma: clearly limited to one bone
- Cephalohematoma often appears on days 2–3
- Subgaleal hemorrhage spreads widely and requires urgent care
How it happens and when it goes away
In the first days, the formation may increase slightly, then it becomes stable and gradually decreases. Blood is absorbed on average in two to eight weeks, and with a large volume it takes longer. Sometimes a dense ridge of calcium forms along the edges, and it seems that the formation does not decrease, but changes shape; Over time, this density usually realigns. Significant blood loss is rare, but with large cephalohematomas, anemia and increased jaundice are possible, since decaying blood increases the bilirubin load. Therefore, such children are monitored with monitoring tests.
- Slight increase in the first days, then stabilization
- Resorption in 2–8 weeks
- Possible edge sealing
- Risk of anemia with high volume
- Increased jaundice of the newborn
- The cosmetic defect is usually temporary
Survey
Most often, an examination by a neonatologist is sufficient: the characteristic location and boundaries of the formation allow a diagnosis to be made. Ultrasound of the soft tissues of the head clarifies the volume and structure, helps to distinguish cephalohematoma from other formations and track resorption. Neurosonography through the fontanel excludes intracranial hemorrhages, especially if the birth was traumatic or there are neurological symptoms. Be sure to monitor the level of bilirubin in case of jaundice and a general blood test in case of a large mass or pallor of the child. X-rays and CT scans are rarely used, only when a skull fracture is suspected.
- Examination by a neonatologist and pediatrician
- Ultrasound of soft tissues of the head
- Neurosonography through the large fontanel
- Bilirubin for jaundice
- General blood test for large lesions
- Bone imaging for suspected fractures
Treatment and care
The main tactic is observation: most cephalohematomas resolve without any intervention. Massaging, heating, or piercing the formation at home is strictly forbidden: this can cause infection and cause suppuration. The puncture is carried out only by a doctor and only when indicated - a very large volume, signs of compression, persistence of the formation for a long time or in case of suppuration, when surgical intervention and antibiotics are required. For severe jaundice, phototherapy is prescribed; for anemia, appropriate treatment is prescribed. The child can be bathed and handled normally, avoiding pressure on the area of formation; The head is turned in different directions when feeding and sleeping.
- Surveillance as a Primary Tactic
- Prohibition on massage, warming and self-punctures
- Puncture or surgical treatment as indicated
- Phototherapy for severe jaundice
- Hemoglobin control at large volume
- Normal care and bathing without pressure on education
- Pediatrician check-ups