Caput Succedaneum and Cephalohematoma Birth Injuries

Caput succedaneum is a birth injury characterized by swelling or edema to a baby’s scalp observable shortly after delivery, as caused by pressure on a baby’s head. This swelling of the newborn scalp extends across the edematous region above the periosteum that crosses suture lines where the bony plates of the skull join together. (In contrast, neonatal cephalohematoma does not cross the suture lines.)

Although this can cause some discomfort, it is not a life-threatening condition. But caput succedaneum can lead to other health issues such as jaundice, it is important that if your child may have this condition that prompt diagnosis and treatment is provided right away. Although the condition will usually disappear of its own accord, the possibility that it is connected with or caused by a more serious condition necessitates greater care to ensure no more serious condition develops.

Because the bleeding is gradual, there may be a delay in the diagnosis of a cephalohematoma.
The most prominent symptom of caput succedaneum is puffiness under the skin of the scalp. As a result, your baby’s head might appear to be abnormally large, bulging around the affected area. Once the swelling goes down, the baby’s head resumes its normal shape. Some additional, less common changes which can affect the appearance of your baby’s head include:

• Bruising (and/or color changes) of the baby’s scalp
• Increased molding (elongation) of the baby’s head

Doctors typically express caput succedaneum in terms of these changes in appearance, and symptoms of minor discomfort. But there is a risk that more serious complications can arise along with or because of the condition.

The most important of these for you to know is newborn jaundice, which is characterized by a yellowish-green skin pigmentation because of bilirubin accumulation. If treated immediately, there are typically no long-term problems that will arise from jaundice. But untreated, jaundice can lead to long-term complications such as kernicterus, a kind of brain damage which can cause:

• Hearing loss
• Athetoid cerebral palsy
• Impaired tooth enamel development
• Permanent upward gaze

Also, if there is a skull fracture underneath your baby’s swelling or if bleeding is extensive, the risks posed by caput succedaneum can be much more serious which is why a full, prompt diagnosis is medically warranted.

Formal testing is not required to diagnose caput succedaneum. Physical examination and observation of apparent symptoms (such as swelling or bruising) will typically suffice.  However, should caput succedaneum arise in utero because of a premature rupturing of the maternal membranes, it can usually be detected via ultrasound.

Because caput hematoma can sometimes be caused by or accompanied by more serious conditions, a greater level of examination may be warranted to ensure there are no other related issues such as a skull fracture or extensive bleeding, which can cause more serious complications.

As caput succedaneum almost always resolves itself within a few days, there is typically no need for treatment. Measures such as trying to drain the scalp area may only exacerbate the condition by leading to infections. If a more serious complication such as jaundice has arisen, additional treatment is recommended to prevent lasting harm to your baby. With jaundice, treatments prescribed vary but may include light therapy, intravenous immunoglobulin, or exchange transfusion.

Cephalohematoma is like caput succedaneum, as both conditions are birth injuries characterized by swelling in a baby’s head. It is a clinical diagnosis. So there is no definitive test for cephalohematoma.

What distinguishes cephalohematoma is that it is a hemorrhage (accumulation) of blood under the scalp and above the baby’s skull. Fortunately, it rarely poses any risk to the brain cells because the blood accumulates above the skull, which means the blood is not applying pressure to the brain.

This condition is also similar but distinct from a subgaleal hematoma, which is characterized by blood accumulating above the periosteum (the membrane covering the outside of bones) directly under the scalp, while cephalohematoma is an accumulation of blood underneath the periosteum. But the similarities stop there. Subgaleal hemorrhages and hematomas carry a grave risk is a bleed that causes a birth injury or death.

The immediate cause of the cephalohematoma’s blood accumulation is damage to the small blood vessels which are located under the scalp.  What happens is pressure on the fetal head causes the rupture of these small blood vessels. This can happen in any vaginal delivery.  The risk is greater if a mechanical device such as a vacuum or forceps is used in labor and delivery.  Other causes include

• An infant’s head is larger than their mother’s pelvic area
• Use of an epidural
• Difficult and prolonged labor

The most obvious symptom of cephalohematoma is a soft, unusual bulge on the back of your baby’s skull. Because of its location under the periosteum, you will probably not see any cut or bruise on the surface of the skin over the bulge.

Expect the bulge to feel harder as the blood calcifies and then shrinks and disappears after a few weeks under normal circumstances. Aside from this bulge, there are often no additional (or obvious) symptoms as a result of cephalohematoma. However, cephalohematoma can cause your child to develop other conditions, such as:

• Jaundice (yellowing)
• Anemia (low red blood cell counts)
• Hypotension (low blood pressure)
• Meningitis
• Infection (such as osteomyelitis)
• Skull Deformation

Furthermore, if accompanied by a more serious condition such as a skull fracture, cephalohematoma can also lead to the growth of this fracture into a leptomeningeal cyst.

Although cephalohematoma is typically not a serious condition, if these other conditions arise from or accompany it there is a possibility that your child may experience developmental delays, motor skill deficiencies, and a non-resolution of the condition. In more acute instances, long-term risks include the development of cerebral palsy. For this reason, your child must be promptly diagnosed and provided with any necessary treatment for this condition, even though it is typically only a minor affliction.

Typically, your child will see the bump resolve on its own within three months. Physicians will not need to provide any treatment unless additional complications arise. Sometimes, the physician may recommend draining the accumulated blood. This is usually not recommended. Complications such as infections and/or abscess formations can arise from draining. If the condition results in a lowering of your baby’s red blood cell count (anemia), additional treatment such as a blood transfusion may become necessary. Should the condition result in jaundice (skin yellowing), light therapy, intravenous immunoglobulin, or exchange transfusion may be prescribed.

If the condition does not rectify itself within a few months, it is recommended that you seek renewed medical attention and consider whether additional treatment is necessary.  A misshaped head is rare but can usually be resolved with cosmetic surgery.

Again, a cephalohematoma will probably last for weeks as opposed to months. Some rare cases of cephalohematoma last over three months that might require further treatment. The problem is that the child has a lump filled with pooled blood. The treatment, if this continues unabated, is to drain that pulled blood out of the child’s head (which is not a big thing but comes with a risk of infection).

A subdural hematoma is a collection of blood located outside the brain. It is different from a cephalohematoma and a caput succedaneum.  The big difference is that a subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that puts pressure on the child’s brain. A subdural hematoma is strongly associated with vacuum-assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established.

Caput medusae are swollen veins on your stomach near your belly button. It is a sign of liver disease. The cause of caput-medusae is portal hypertension  This is high pressure in the portal vein. You can see caput medusae in newborns. But it is rare. This condition is unrelated to caput succedaneum.