Cephalohematoma is bleeding between the skull and the membrane (periosteum) underneath the skin. The blood comes from blood vessels crossing the membrane and collects in a pocket between the two layers. It is usually caused by prolonged labor during the second stage (from the time of complete dilation to delivery of the baby), forceps delivery injuries, or vacuum extractor delivery injuries.
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Cephalohematoma Symptoms and Risk Factors
Cephalohematoma injuries are usually apparent because of an unnatural bulge on the baby’s head. When there is a small amount of blood, the bulge will be soft. Larger masses are typically firm to the touch.
These types of injuries are more frequent for first-time deliveries. Also, large babies and babies delivered by forceps or vacuum are more likely to have cephalohematoma injuries.
Medical Problems Associated with Cephalohematoma
Children with cephalohematoma must be closely monitored after birth. One of the first concerns is whether the cephalohematoma is a sign of an underlying skull fracture, particularly if forceps or vacuum were used during delivery. It may also indicate head trauma, which can cause a wide range of developmental delays.
Children with cephalohematoma are at a higher risk of developing the following problems:
- Jaundice: Jaundice is a high level of bilirubin in the blood. It can occur after cephalohematoma birth injuries because the baby’s body needs to replace lost red blood cells. Signs of jaundice include yellow skin and yellow eyes. The liver will gradually dispose of the excess bilirubin, and treatment is usually not necessary. In extreme cases, babies may need to be treated with special blue lights (phototherapy) to help break down the bilirubin in the skin. If treatment is necessary but not provided, babies with jaundice can develop cerebral palsy, kernicterus, loss of hearing, and brain damage.
- Infection: Though rare, cephalohematomas can become infected, particularly when a doctor attempts to drain it. Draining cephalohematomas is usually a violation of the standard of care. Untreated, these infections can cause bone infection (osteomyelitis) and other complications.
- Anemia: When the blood loss is high, a baby may become anemic. Anemia is dangerous because it means the body can’t send sufficient oxygen to the organs, including the brain. Babies with anemia may be easily fatigued, weak, and uninterested in feeding. Severe anemia must be treated immediately to avoid permanent injuries.
Treatment of Cephalohematoma Injuries
Doctors should not drain the cephalohematoma because of the risk of infection. Instead, it should be left alone, and it will eventually harden and become reabsorbed into the body. This process may take a few months. If other complications are caused by the cephalohematoma—like jaundice, infection, or anemia—then those conditions must be treated when necessary.
