###### Created: 2024-06-17 17:34 ###### Areas & Topics: #medicine #paediatrics ###### Note Type: #permanent ###### Connected to: [[Newborn Infant Physical Examination (NIPE)]] - Neonatal Head Shape Abnormalities can occur for various reasons, with some of the more common ones outlined below. ### Cranial Moulding - An abnormal head shape that is caused by pressure on the skull during birth. - Cranial moulding is a common finding and typically resolves within a few days. ![[main-qimg-10a9c9e6998d1d69bfbee0d3d2a364ff-lq.jpg]] ### Caput Succedaneum - Caput Succedaneum is characterised by a diffuse subcutaneous fluid collection (i.e. swelling/oedema) of the scalp around the presenting part (vertex) of the baby's head. - It is caused by pressure on the presenting part of the head during delivery, leading to swelling and fluid building up under this area. - This is most commonly due to extended labour, but can also occur from forceps or Vaccum-assisted (Ventoose) delivery. - It typically does not cause complications and resolves over the first few days of life. Features - Present at Birth - Soft, Puffy Swelling (due to localised oedema) - Poorly-Defined Margins - Crosses Suture Lines - Resolves within Days N.B. bruising, petechiae or ecchymosis might also be present around the swelling as well. ![[Caput-Succedaneum-vs-Cephalohematoma.jpg]] ### Cephalhaematoma - Cephalhaematoma is characterised by a subperiosteal (i.e. under the skull periosteum) haemorrhage occurring hours or days after delivery. - It is caused by rupture of the blood vessels crossing the periosteum due to increase pressure on the foetal head during birth. - It is bound by suture lines (as it is under the periosteum) and typically occurs in the parietal or occipital region of the skull (but can occur anywhere). - A complication of cephalhaematoma which can occur is neonatal jaundice, as red blood cells from the bleed will break down over time and produce bilirubin which will then be absorbed. - This means babies with cephalhaematoma should be carefully checked for signs of jaundice or have their bilirubin taken as a screening measure. Features - Presents Hours or Days after birth - Firm, Fluctuant Swelling - Well-Defined Margins - Does not cross Suture Lines - Resolves within Weeks/Months N.B. over time as the blood is calcified and reabsorbed, the texture of the swelling may become harder or more indurated. ![[71-cephalhaematoma-1024x1024.jpg]] ### Subgaleal Haemorrhage - Subgaleal haemorrhage is a rare neonatal condition characterised by bleeding which occurs in the loose areolar tissue space between the galea aponeurotica and the skull's periosteum. - It typically occurs when shearing force during delivery cause traction to separate the scalp and bony calvarium, shearing the bridging vessels within. - The subgaleal space is a large potential space that expands the whole of the skull, meaning bleeding in this area can potentially be massive and/or life-threatening. Features - Sudden appearance (usually following delivery) - Firm, Fluctuant Swelling - Crosses Suture Lines - Signs of Severe Blood Loss (pallor, tachycardia, hypotension, shock etc.) ![[A-sever-fluctuant-swelling-on-the-head-of-our-patient-with-Subgaleal-hemorrhage_Q320.jpg]] ### Craniosynostosis - Craniosynostosis is a condition caused by the premature fusion of the cranial sutures. - It typically results in skull deformity and/or raised ICP symptoms. - It is treated surgically by excising the prematurely fused sutures and correcting any skull deformities. ![[craniosynostosis-scaled.jpg]] ### Resources NIPE - GeekyMedics https://geekymedics.com/newborn-baby-assessment/#References PassMed Jacob K, Hoerter JE. Caput Succedaneum. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574534/ Raines DA, Krawiec C, Weisbrod LJ, et al. Cephalohematoma. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470192/ Dumpa V, Kamity R. Birth Trauma. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539831/ Betances EM, Mendez MD, Das JM. Craniosynostosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544366/