![]() Management depends on the location and extent of the bleeding. Subdural hemorrhages can occasionally be found incidentally in asymptomatic neonates. Presenting signs/symptoms include bulging fontanelle, altered consciousness, irritability, respiratory depression, apnea, bradycardia, altered tone, and seizures. Operative vaginal delivery is a major risk factor, and hemorrhage over the cerebral convexities is the most common site. Subdural Hemorrhage is the most common type of intracranial hemorrhage in neonates. Prompt neurosurgical intervention is necessary due to the potential to deteriorate rapidly. Diagnosis is via CT or MRI of the head, which shows a convex appearance of blood collection in the epidural space. Signs include bulging fontanelle, bradycardia, hypertension, irritability, altered consciousness, hypotonia, seizures. Traumatic intracranial hemorrhages include epidural, subdural, subarachnoid, intraventricular, and less frequently intracerebral and intracerebellar hemorrhages.Įpidural hemorrhage is rare in neonates and usually accompanies linear skull fractures in the parietal-temporal region following an operative delivery. A workup for bleeding disorders may be considered in selected cases if the degree of bleeding is out of proportion to the trauma at birth. The hemorrhage itself is not drained and allowed to resorb over time. Treatment includes supportive care with early recognition and restoration of blood volume using blood or fresh frozen plasma to correct the acute onset hypovolemia. Since the subgaleal space is a significant potential space extending over the entire area of the scalp from the anterior attachment of the galea aponeurosis near the frontal bones to the posterior attachment at the nape of the neck, there is a potential for massive bleeding into this space that could result in acute hypovolemic shock, multi-organ failure, and death. It has been estimated to occur in 4 of 10000 spontaneous vaginal deliveries and 59 of 10000 vacuum-assisted deliveries. A difficult vaginal delivery resulting in the use of forceps or vacuum is the most common predisposing event in the formation of subgaleal hemorrhage. The injury occurs when traction pulls the scalp away from the stationary bony calvarium, resulting in the shearing or severing of the bridging vessels. Subgaleal hemorrhage: subgaleal hemorrhage is a collection of blood in the loose areolar tissue space between the galea aponeurotica and the skull's periosteum. However, complications such as calcification, deformities of the skull, infection, and osteomyelitis can occur. The usual course is a spontaneous resolution in 2 weeks to 3 months without intervention. ![]() It is more common in deliveries involving vacuum or forceps and occurs in up to 2.5% of all deliveries. Limited by the periosteal attachment to the underlying skull bones, the swelling does not cross suture lines and is often unilateral. Still, computed tomography (CT) or magnetic resonance imaging (MRI) of the brain is recommended if there is suspicion of intracranial injury or neurologic symptoms.Ĭephalohematoma: Cephalohematoma is a localized sub-periosteal collection of blood resulting from the rupture of blood vessels traversing from the skull to the periosteum. Plain film radiographs of the skull usually clarify the diagnosis. These fractures could be linear or depressed and are usually asymptomatic unless associated with an intracranial injury. Skull Fractures: Skull fractures from birth trauma are most often a result of instrumented vaginal delivery. Rare complications include bruising of the skin over the swelling with necrosis resulting in scarring and alopecia, and rarely systemic infection. No intervention is required, and it typically resolves over the first few postnatal days. The edema is above the plane of the periosteum, and hence the scalp swelling crosses suture lines. It is a subcutaneous swelling and edema of the scalp between the skin and the periosteum due to local venous congestion from the birth canal's pressure on the presenting part. Head trauma can include superficial lesions, extracranial and intracranial hemorrhages, and fractures of the skull bones.Ĭaput Succedaneum: Caput succedaneum is a common scalp swelling in newborns. A summary of the common traumatic clinical conditions occurring related to birth is listed below. Other less common locations include the face, abdomen, and lower limbs. The common sites for birth trauma can include the head, neck, and shoulders. The clinical management and prognosis of infants with birth injuries vary widely depending on the injury's type and severity.
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