Cephalohematoma is a condition that affects newborns and is marked by hemorrhage beneath the skin, between the periosteum and the skull. The hemorrhage is caused due to rupture of blood vessels that cross the periosteum. It may be noted that the periosteum is the membrane layer that encloses the outer surface of skull bones.

The condition  is related to a form of subperiosteal inflammation. However, it cannot pass the suture lines and its further advanced gets restricted by the bones in the region.

Hemorrhage is a gradual process and hence the blood vessels rupture is not instantly noticeable post delivery. The first symptoms may in fact be visible only many hours after delivery. In most cases, the blood gets reabsorbed when the newborn is between ages 2 weeks to 3 months. If skull fracture occurs along with cephalohematoma, then a bony bump may persist after healing.

Male newborn babies are more prone to experiencing this condition as compared to female babies. The condition is observed in about 1 to 2 percent of all live births; it is more common in childbirths that feature use of birth-assist medical tools. Hemorrhage can be bilateral or unilateral. The former is observed in about 15 percent of the cases. Hemorrhage tends to cure on its own with any medical intervention.

Cephalohematoma is not associated with any damage or trauma to the brain cells. The hemorrhage occurs between the inner layers of skin and the skull; thus there is no link to the brain. It is not a serious condition, but can be dangerous if neurological complications arise.

Symptoms of cephalohematoma

Some of the signs and symptoms that may occur along with cephalohematoma are listed below:

• There is swelling but it cannot cross or expand because of limitations placed by the suture lines. The swelling has clear boundaries; it is the biggest on the second or third day from the day of the hemorrhage.
• Cephalohematoma that develops at the brain levels will take many weeks to get reabsorbed. Associated inflammation also tends to subside slowly.
• There is increased risk of infection, which can then raise the susceptibility to complications like meningitis or osteomyelitis.
• There may be abnormal bulges or bumps on the newborn’s head. The bump is soft if the hemorrhage is marked by leakage of minor quantity of blood. However, the bulge with be firm if the hemorrhage is extensive.
• The condition may sometimes be indicative of fracture at the skull level.
• The hemorrhage region may possibly remain calcified, but the center is softer. This condition is medically termed as depressed fracture. Blood accumulation may cause the associated regions to feel fluctuant to touch.
• In severe cases of cephalohematoma, the affected babies may suffer from jaundice, low blood pressure, and/or anemia.
• Hyperbilirubinemia, anemia, and infection are regarded as complications of the condition. However in most cases, infection usually happens during an attempt to drain or remove the blood.

Causes of cephalohematoma  

It s commonly caused due to the below listed factors:

• If the second phase of labor is difficult or prolonged. The second labor stage begins after full dilation and finishes after the actual birth of the baby.
• If the head of the newborn/un-delivered baby is bigger than the pelvic region of the mother
• If head trauma occurs during birth or at any stage before delivery
• Use of certain tools or instruments, like forceps or ventouse, for the delivery process. Use of these tools can injure the head of the baby, cause the rupture of tiny blood vessels in periosteal area, and result in hemorrhage.
• If it’s a first pregnancy for the mother
• If the baby’s size is large, i.e., macrosomia. Babies that are bigger than the normal standard size carry a higher risk of cephalohematoma.
• If the head of the baby gets banged against the pelvic bone of the mother during the labor process
• Cephalohematoma is more common in vaginal delivery births. However, it has also occurred in C-section childbirths as well.
• Vitamin C deficit is not an actual cause of cephalohematoma, but can increase the risk to development of the condition.

Treatment of cephalohematoma

The condition usually does not require any treatment as the condition heals without any medical assistance in about 3 months.

Parents should however seek immediate medical attention if they notice any abnormal symptoms in the baby, such as a bump on the head. Doctor will suggest varied tests like MRI, CT scan, etc., and keep the baby under observation. After checking the results, the doctor will prescribe therapies, treatments, medicines, or surgeries if needed.

• In case of serious hemorrhage marked by anemia and lowering of the RBC count in the baby, doctors will carry out a blood transfusion.
• Breakdown of blood increases bilirubin levels, thereby heightening the risk to jaundice. Jaundice/high level of bilirubin is treated with phototherapy and other treatment options.