Cephalohematoma: Types, Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

A cephalohematoma is a blood collection between a newborn's scalp and skull. Blood clots outside of blood vessels are called hematomas. The definition of "cephalo" is "head."

This kind of birth damage happens when pressure causes blood vessels in the baby's scalp to burst. Blood clots behind the scalp, hardening over time to form a tender bump.

Types of Cephalohematomas

Neonatal cephalohematomas are categorized by medical experts based on when symptoms first appear.

Newborn hematomas can be of two types:

• Acute Hematoma: The symptoms will appear hours or minutes after the baby is delivered.
• Chronic Hematoma: It may take several days or weeks after delivery for a chronic neonatal hematoma to manifest symptoms. Inappropriate treatment for acute neonatal hematoma can lead to chronic infant hematoma. 

Improved outcomes could arise from an early diagnosis. If not correctly detected and treated, problems from either type of infant cephalohematoma can lead to brain damage or even death.

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Causes of Cephalohematomas

A newborn's cephalohematoma usually appears during childbirth during labor. But after delivery, it can take a few hours or days before it forms. During labor or delivery, the baby's head may be subjected to extreme pressure or stress, which could burst the fragile blood vessels on the scalp and cause a cephalohematoma. 

Cephalohematomas can arise from a variety of birth-related head trauma scenarios.‌ When a baby enters the birth canal and strikes the mother's pelvic bone, this happens frequently. When this happens, the contractions force the head to continue moving until the delivery canal is passed.‌

During labor, there is a risk of head damage from two common birth aids: vacuum extractors and obstetrical forceps. ‌These medical devices are used when a mother's uterine contractions are not strong enough to push the baby through the delivery canal. Doctors employ these instruments to retain the baby's head during delivery; the power of the application may rupture the baby's blood vessels.

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Symptoms Of Cephalohematoma

The most common symptom is a little bulge or lump at the back or top of your baby's skull. Usually, there won't be any cuts, bruises, or redness on the skin around the protrusion.‌

Cephalohematomas vary in size and might be more or less noticeable. The lump is initially soft, but when the blood clots and begins to calcify, it becomes denser and tougher. After a few weeks, the bulge starts to recede, resulting in a "crater-like" appearance, with the middle of the bump usually going away before the edges. 

In addition to the protrusion, neonatal cephalohematoma may manifest with internal symptoms. These are a few of the signs:

• Infection: This potentially fatal outcome is possible in infants with cephalohematomas.
• Jaundice: On rare occasions, a cephalohematoma may increase the newborn's risk of jaundice due to elevated blood bilirubin levels.
• Anemia: Another common symptom is low red blood cell levels.

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Risk Factors Of Cephalohematoma.

The following factors make a neonate more susceptible to a cephalohematoma:

• Assistance in delivery with forceps or vacuum extraction.
• Pain control with epidurals during childbirth.
• A baby with fetal macrosomia has an abnormally large and heavy weight, exceeding 8 pounds, and 13 ounces.
• Twins or triplets.
• Long and tough vaginal delivery.

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What Is The Difference Between Cephalohematoma From Caput Succedaneum?

The development of the cephalohematoma and caput succedaneum also called caput or newborn conehead can occur concurrently or independently. Generally speaking, neither disease calls for therapy.

A cephalohematoma is the term for a blood clot (hemorrhage) that appears beneath a newborn's scalp. It appears soon after birth. The bulge is visible in the back of the head and does not go beyond the lines joining the individual's head bones. It can take months for it to vanish.

Caput succedaneum usually causes edema, or swelling, on the top of the head, which is noticeable from birth. This enlargement feels spongy on the scalp, appears soon after birth, and crosses suture lines.

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Diagnosis Of  Cephalohematoma

Normally, your doctor will perform a thorough physical check on your infant just after delivery and at your first appointment with a pediatrician, which is one to three days later.

Even while a bulge alone may be enough to diagnose you, your doctor may occasionally request additional tests, such as:

• MRI
• CT scans
•  X-ray
• ultrasounds

Treatment Of Cephalohematoma

Newborns with cephalohematomas usually heal on their own, without the need for medical assistance. It goes away from the lump in a few weeks or months. Sometimes a doctor will try to drain it, but it's not always necessary. You will be advised by your doctor to closely monitor any unusual symptoms in the area.

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Complications Of Cephalohematoma

Possible problems from cephalohematomas include the following:

• Anemia: A cephalohematoma causes blood loss in the baby's circulatory system. This could lead to anemia (low red blood cell count). A larger cephalohematoma is more likely to cause anemia.
• Calcifications: In cephalohematomas that persist longer than five weeks, hardened bone deposits, or calcifications, may form around the tumor. This rare problem might affect the way the skull develops. Corrective surgery is necessary for the elimination of calcification in newborns.
• Infections: A cephalohematoma increases the risk of infections. In rare cases, it can lead to potentially lethal conditions like cellulitis, osteomyelitis, or sepsis.
• Jaundice: When a baby's body absorbs blood from the cephalohematoma, there may be a spike in bilirubin levels in the blood. Your infant may have yellow skin or eyes.
• Skull fractures: Up to 1 in 4 newborns with cephalohematomas had a linear skull fracture. As unsettling as this may sound, this type of fracture does not result in the shifting of the bones in the head. In the absence of medical intervention, a linear fracture of the skull will gradually heal.

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