Newborn Cephalohematoma

Becoming a new parent can be a wonderful experience, but when your baby suffers an injury during birth from medical negligence, the situation can become scary and unpredictable. During a difficult birth, physicians may deploy different methods and delivery tools like forceps or vacuums to try and ease the process on the mother and baby. Unfortunately, such measures can increase the risk of a baby developing birth injuries such as newborn cephalohematoma.

Newborn cephalohematoma is a medical term that refers to an accumulation of blood under a baby’s scalp, typically after delivery. Often referred to as infant hematoma, this condition occurs when small blood vessels crossing the thin tissues above the skull bone are ruptured, causing blood to build up between the thin layer of tissue and skull bone. The bleeding process is gradual, so it can take hours or even days for a newborn to develop clear signs of cephalohematoma.

Is Newborn Cephalohematoma a Serious Condition?

While its appearance is concerning, newborn cephalohematoma often resolves on its own. Your doctor will monitor the condition, but it generally does not cause long-term health consequences. The collection of blood occurs on top of the baby’s skull, and there’s no bleeding or pressure on the infant’s brain. However, some complications may arise as a result of newborn cephalohematoma.

How Common is Newborn Cephalohematoma?

Newborn cephalohematoma occurs in approximately 0.4%–2.5% of all births. The incidence is higher in vacuum or forceps-assisted deliveries, accounting for 3-4% of births. Newborn cephalohematoma is most common with the delivery of:

  • Male babies 
  • Babies of first-time mothers 
  • Device-assisted births
  • Overly large babies
  • Babies malpositioned in the birth canal

Causes of Newborn Cephalohematoma

Newborn cephalohematoma results from a minor injury on the infant’s head due to pressure during birth or external physical trauma. The exact source of trauma can vary. However, the most common cause results from the baby’s head impacting the mother’s pelvic bone as the baby progresses down the birth canal. In such cases, the force of labor contractions continuously pushes the baby’s head against the pelvis until it exits the birth canal. Some of the risk factors contributing to newborn cephalohematoma include:

Mother carrying her new born

Size of the Baby

When the fetus grows to over 9lbs during gestation, it increases the risk of newborn cephalohematoma. A large baby is likely to experience difficulties moving through the birth canal. The increased stress, compression on the baby’s head, and the prolonged birthing process increase the risk of this condition. An average-sized baby can also experience similar risks if the mother has a relatively small pelvis.
Multiple infant births

Multiple Infant Births

If a mother is carrying twins or triplets, the risk of newborn cephalohematoma can increase during delivery.
Pregnant woman

Position of the Infant

If the infant is facing upwards, lying sideways, or in breech presentation, it can complicate and prolong the delivery process, consequently increasing the risk of newborn cephalohematoma.

Doctor carrying a new born

Timing of Birth

If the fetus is born prematurely, its body tissues, skull, and vessels are not fully developed, making them more fragile and prone to rupture during labor.
Pregnant woman in pain
Complicated or Lengthy Birthing Process

Anything that prolongs or complicates the labor and delivery process automatically increases the risk of newborn cephalohematoma. The fetus is more likely to get injured in the birth canal during a strenuous delivery or experience injury from being pressed against the mother’s pelvis for extended periods of time.

Assisted delivery device

Using Assisted Delivery Devices

When a mother has weak uterine contractions or the baby has difficulty exiting the birth canal during a particularly long or difficult labor, the medical staff may use birth assistance tools like vacuum pump extractors and obstetrical forceps. Device-assisted births may also occur because:

  • The labor process is not progressing
  • The baby is distressed
  • The mother is injured, sick, or cannot push
  • The baby’s head is malpositioned

Unfortunately, the use of these tools can cause childbirth trauma leading to newborn cephalohematoma. Even with skillful use of the devices, they can still create enough force to damage blood vessels in the baby’s head, triggering newborn cephalohematoma.

Doctor carrying a new born baby

Physician or Medical

Practitioner Negligence
Medical professionals are trained to identify and reduce the risk of newborn cephalohematoma. If risk factors are present during delivery, doctors will take precautionary measures to reduce the occurrence of trauma, monitoring the baby for newborn cephalohematoma after delivery.

If the delivering doctor fails to take proper precautions to reduce the risk of newborn cephalohematoma or your baby does not receive immediate medical attention after sustaining head trauma, the doctor can be held accountable for medical negligence. Similarly, misusing birth assistance devices or failing to address the baby’s distress promptly can constitute medical malpractice.

Types of Newborn Cephalohematoma

Newborn cephalohematoma can either be acute or chronic. In acute cases, the symptoms appear within hours of delivery, whereas the symptoms of chronic newborn cephalohematoma may not appear until days or even weeks later.

While most infants treated for acute newborn cephalohematoma recover without complications, they may develop chronic newborn cephalohematoma if the condition is left untreated for too long. Therefore, early diagnosis and immediate treatment are critical.

Signs of Newborn Cephalohematoma

The hallmark symptom of newborn cephalohematoma is a bulge on the baby’s head that forms hours or days after birth. At first, the bump feels soft to the touch, then it gradually hardens and changes in appearance as the pooled blood under the scalp calcifies.

The calcified blood under the scalp erodes with time, causing the bulge to shrink away. Usually, the area around the center of the bump erodes more quickly than the outer edges, creating a crater or ring-like appearance. The bulge usually takes two weeks to three months to disappear.

Babies with newborn cephalohematoma often present additional symptoms, including:

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Bacterial infections

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Feeding difficulties

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Pain in the skull

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High-pitched cry

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Large head circumference

Treatment for Newborn Cephalohematoma

Usually, the appearance of a bulge on the baby’s head is the first sign of a newborn cephalohematoma diagnosis. If present, doctors will then conduct a full-body physical examination of the baby.

If the infant exhibits newborn cephalohematoma symptoms, the physician will monitor the baby’s head size against normal growth expectations. The medical staff will also check the baby’s hematocrit level or the number of red blood cells relative to their blood volume. If hematocrit levels are lower than they should be, the physician will likely order imaging scans, including X-rays, CT scans, MRIs, and ultrasounds.

With immediate and proper treatment, infants diagnosed with newborn cephalohematoma are likely to recover without developmental or physical challenges. Complications linked to newborn cephalohematoma are often easily manageable if the birth injury is diagnosed and treated promptly before additional symptoms escalate. Identifying signs of head trauma in newborns is essential for rapid medical intervention.

Complications of Newborn Cephalohematoma

Although some head traumas cause minimal long-term issues, newborn cephalohematoma can trigger complications that may prove harmful to an infant. Such complications include:

The gradual bleeding of newborn cephalohematoma can result in significant blood loss, leading to a deficit of red blood cells. Also known as anemia, this condition is treatable via phototherapy, blood transfusion, iron supplements, or antibiotics.

In some cases, newborn cephalohematoma is associated with a skull fracture. Although this may sound alarming, it’s usually not severe and doesn’t require surgery, as long as the two parts of the bone are not displaced relative to each other. Treatment involves careful monitoring while the bone heals.

The bulge caused by newborn cephalohematoma presents a risk of primary or secondary infections. Skin lesions make the site more vulnerable to bacterial infections, developing within weeks after birth, causing inflammation and fever. These infections can also lead to more severe ailments such as sepsis and meningitis. Treatment for infection is through the administration of antibiotics.

This condition causes yellowing of the baby’s skin and the whites of the eyes. It occurs due to excessive levels of bilirubin, which is a substance that is created during the breakdown of old red blood cells. If left untreated, jaundice can cause cerebral palsy, hearing loss, and permanent disabilities. Newborn jaundice is treatable with light therapy and careful monitoring.

This condition occurs when bone deposits form and harden around the pooled blood. While uncommon, calcification is a severe complication that can lead to severe skull deformities. Prompt surgical intervention is vital for treating cephalohematoma calcification.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.