Cephalhaematoma due to birth injury (Draft of the clinical recommendations)

Cephalhematoma is a limited, hard, tense area of hemorrhage overlying the cranial bones, bounded by its sutures, and is subperiosteal. Risk factors for cephalhematoma formation can be divided into three main groups: maternal, birth, and fetal. Maternal factors include the woman’s age (under 16 and over 35 years), pelvic abnormalities, and chronic maternal diseases. Birth risk factors include the state of the mother’s birth canal, the method of delivery, prolonged and rapid labor, oligohydramnios, and the use of obstetric aids. Fetal risk factors include prematurity, postmaturity, breech or breech presentation, developmental abnormalities, large head size, and macrosomia. Cephalhematoma occurs in approximately 0.2 to 4.0% of live births; among premature infants, the incidence is 20%. Cephalhematoma is classified as an extracranial formation along with caput succedaneum (birth tumor), subgaleal hemorrhage and can be focal and widespread. Cephalhematoma usually forms during the first three days of a newborn’s life and can be localized on any bone of the cranial vault. Cephalhematoma resorption begins by the 10 th to 14 th day of life. In case of large hemorrhages, hypotension, anemia, jaundice develop in some cases, neurological symptoms usually occur when cephalhematoma is combined with intracranial hemorrhage. Complications of cephalhematoma include infection and ossification. Along with visual examination and daily measurement of the hemorrhage size with assessment of its density, mobility, and painfulness, the newborn is recommended to undergo neurosonography and/or radiography of the entire skull in one or more projections to exclude skull bone fractures and neurosonography, computed tomography or magnetic resonance imaging of the brain to exclude intracranial hemorrhage, as well as consultation with a neurologist if intracranial hemorrhage is suspected and/or confirmed, as well as if the neurological status changes. Treatment consists of repeated visits to a pediatrician and surgical intervention in case of cephalhematoma suppuration; in the presence of intracranial hemorrhage, conservative or surgical treatment of intracranial hemorrhage is recommended.