Cephalohematoma: Complications & Treatment

Cephalohematoma is a form of child birth injury, common after a protracted labor, in which ruptured blood vessels allow blood to collect between the skull and the periosteum, a membrane of soft tissues that covers the outer surface of the skull. In non-technical terms, cephalohematoma is a collection of blood that develops beneath the scalp of a newborn baby’s head, usually because of trauma during labor or delivery.

What Is Cephalohematoma?

Cephalohematoma is usually a minor complication of delivery. Because the blood is collecting underneath the periosteum, not underneath the skull bones, there’s very little risk, if any, that this form of hemorrhage could come to affect brain tissue. Between 1% and 2% of all babies born in the United States will develop cephalohematoma, according to HealthLine.

Causes & Healing Time

Children usually develop this form of skull bleeding after going through the rigors of a difficult labor. Repeated contractions can compress a baby’s head over and over, ultimately leading to blood vessel damage. This pathway is particularly common when the baby is large for gestational age or has a large head.

In addition, cephalohematoma is particularly common after an instrument-assisted delivery, in which obstetricians use tools, usually forceps or a vacuum extractor, to pull the child through the birth canal. Since these instruments are normally fixed to a baby’s head, the trauma can rupture blood vessels in the skull, leading to a build-up of blood below the skin. In most cases, the accumulation of blood will be reabsorbed into the body within three months, often earlier.

Symptoms, Signs & Associated Medical Conditions

Cephalohematomas aren’t usually present directly after birth. It usually takes a few hours or days for the blood to build up. While some children won’t develop any external signs of injury, most parents notice a soft bulge at the back of their baby’s head. That’s the cephalohematoma and, in some cases, it can be hard to miss.

But since the blood is collecting underneath the periosteum, which is connected to a portion of bone, there’s really no chance that the blood will spread further. Cephalohematoma are usually unilateral, occurring only on one side of a child’s head, but that’s not always the case.

Over time, you might notice that the bump on your child’s head is getting harder, which happens because the blood is calcifying. It’s usually not long before the blood begins to be absorbed and the swelling subsides.

Normally, this bulge is the only external sign of a cephalohematoma. You probably won’t see any cuts on the surface of your child’s head, and it’s unlikely that your baby’s behavior would change due to the accumulation of blood. Lab tests conducted by your doctor, though, may be able to find evidence of the cephalophematoma’s effects inside your child’s body.

Jaundice

Children who develop cephalohematoma are more likely than other kids to experience jaundice, the common newborn condition that turns some children a shade of yellow.

Jaundice is caused by an excessive amount of bilirubin. That’s a yellow pigment created as a byproduct when old blood cells break down. As the blood inside a cephalohematoma breaks down, it can release large amounts of bilirubin, which your baby’s liver may have trouble dealing with.

Anemia

In serious cases, when a great deal of blood has flowed under the scalp, cephalohematoma can also be associated with anemia, a deficiency in healthy red blood cells.

In one sense, cephalohematoma is a form of blood loss. While the blood is still contained inside your baby’s body, it’s no longer flowing through the cardiovascular system. Anemia is a potential, though rare, complication of this blood loss, since the red blood cells are accumulating under the scalp, rather than flowing through your child’s body. Severe cases of anemia may require a blood transfusion.

Risks Of A Calcified Cephalohematoma

Some cephalohematomas fail to absorb (or “resorb”) completely after the blood has calcified into a hard mass. That leaves something akin to a benign tumor sitting between the skull and the periosteum, but remember that, at this time in childhood development, a baby’s skull is still very soft.

As a result, the hard collection of calcified blood can push downward, pressing into the baby’s skull. While brain damage is still very unlikely, a persistent cephalohematoma can increase the risk for infections, including the rare bone infection known as osteomyelitis.

Even so, most pediatricians would discourage attempting surgery to remove a calcified cephalohematoma, since surgery is very risky and cephalohematoma are almost never dangerous.

Treatment For Cephalohematoma

As we explained earlier, most cases of cephalohematoma resolve on their own, as the blood is resorbed into a child’s body. Larger accumulations can be drained surgically, but this is a rare step only undertaken after doctors are fairly certain that the accumulation won’t subside of its own accord. Needless to say, a surgical intervention poses significant complication risks.

Children who develop jaundice can be treated through phototherapy, in which exposure to a special form of light helps their bodies break down the pigment bilirubin.