Cephalhematoma

Cephalhematoma is a collection of blood between the skull bone and its periosteal covering that occurs after birth. It is a subperiosteal hemorrhage typically resulting from birth trauma and is limited to a single bone by the boundaries of the periosteum; unlike caput succedaneum, it does not extend across suture lines.

In newborns, cephalhematoma usually becomes apparent within hours to a few days after delivery. The swelling is soft and fluctuant, often over the area of presenting part, but it remains confined to one bone and does not cross sutures. It may be associated with scalp ecchymosis and can be noted on the maternal or obstetric history as a difficult or assisted delivery.

Diagnosis is usually clinical. Imaging is not routinely required unless there is concern for fracture, intracranial hemorrhage, or if the presentation is atypical. When imaging is performed, ultrasound is often sufficient; CT or MRI is reserved for selected cases.

Most cephalhematomas resolve spontaneously as the collected blood is reabsorbed, typically over 2 to 6 weeks. Complications are uncommon but may include significant hyperbilirubinemia from red blood cell breakdown, which should be monitored, especially in large hematomas. Rarely, anemia or infection can occur; very rarely, large hematomas can relate to underlying skull fracture or neurological issues, necessitating further evaluation.

Management is supportive, focusing on observation and routine newborn care. No drainage or surgical intervention is indicated in most cases. Parents should be advised to seek care if the infant develops fever, worsening swelling, vomiting, poor feeding, or signs of neurological concern.

See also caput succedaneum and subgaleal hemorrhage.