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Cephalohematoma – Causes, Symptoms and Treatment

A cephalohematoma is a collection of blood between a newborn's skull bone and its periosteum, typically caused by birth trauma or assisted delivery.

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Things worth knowing about "Cephalohematoma"

A cephalohematoma is a collection of blood between a newborn's skull bone and its periosteum, typically caused by birth trauma or assisted delivery.

What is a Cephalohematoma?

A cephalohematoma is a localized accumulation of blood between the outer surface of a skull bone and the periosteum (the fibrous membrane covering the bone) in a newborn. It occurs when small blood vessels in the periosteum rupture during birth, causing blood to pool in the subperiosteal space. Because the periosteum is firmly attached at the suture lines, the swelling is always confined to a single bone and does not cross suture boundaries.

Cephalohematomas occur in approximately 1 to 2 percent of all births and are among the most common birth-related injuries. They are distinct from a caput succedaneum (birth caput), which is a more superficial swelling that can cross suture lines.

Causes

A cephalohematoma is caused by mechanical stress on the newborn's skull during delivery. Common contributing factors include:

Prolonged or difficult labor
Assisted delivery using a vacuum extractor or obstetric forceps
Cephalopelvic disproportion (a mismatch between the size of the baby's head and the mother's pelvis)
Rapid delivery with intense pressure on the skull

Symptoms and Clinical Presentation

A cephalohematoma typically becomes visible within hours to days after birth as a soft, fluctuant swelling on the back or side of the newborn's head. Key clinical features include:

Swelling does not cross suture lines
Soft, fluctuant consistency
No discoloration of the overlying skin (unlike a caput succedaneum)
Gradual enlargement over the first few days
Spontaneous resolution over several weeks

As the collected blood is broken down by the body, bilirubin is released, which may lead to or worsen neonatal jaundice (hyperbilirubinemia).

Diagnosis

Diagnosis is primarily clinical, based on physical examination of the newborn. The physician assesses the location, size, and boundaries of the swelling. Additional investigations may include:

Ultrasound: To confirm the subperiosteal blood collection and rule out an underlying skull fracture
Blood tests: To monitor bilirubin levels if neonatal jaundice is suspected
X-ray or MRI: Reserved for cases where a fracture or other complication is suspected

Treatment

Most cephalohematomas resolve spontaneously without specific treatment within 2 to 12 weeks. Management focuses on monitoring and addressing any complications:

Regular follow-up: Routine check-ups with a pediatrician to monitor the resolution of the hematoma
Bilirubin monitoring: If bilirubin levels become elevated, phototherapy (light therapy) may be required to treat jaundice
Pain management: Rarely necessary but may be considered in cases of large hematomas
Aspiration or surgical drainage: Only indicated in rare cases of very large hematomas or calcification complications

Routine needle aspiration of the hematoma is generally not recommended, as it carries a significant risk of introducing infection without providing substantial clinical benefit.

Complications

Although cephalohematomas are generally benign and self-limiting, rare complications can occur:

Calcification: The hematoma may calcify, forming a hard lump on the skull. This usually resolves over months to years.
Neonatal jaundice: Elevated bilirubin from blood breakdown may require phototherapy
Anemia: Large hematomas can contain enough blood to cause significant blood loss and anemia in the newborn
Infection: Very rare, but possible -- particularly if the hematoma is manipulated or aspirated

Prognosis

The prognosis for cephalohematoma is excellent. The vast majority of affected newborns recover completely without any long-term consequences. However, regular follow-up with a pediatrician is recommended to detect and manage any potential complications early.

References

Kliegman RM, et al. Nelson Textbook of Pediatrics. 21st Edition. Elsevier, 2020.
World Health Organization (WHO). Guidelines on Basic Newborn Resuscitation. WHO Press, 2012.
Colditz MJ, Lai MM, Cartwright DW, Colditz PB. Subgaleal haemorrhage in the newborn: a call for early diagnosis and aggressive management. Journal of Paediatrics and Child Health. 2015;51(2):140-146.

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