CAPUT SUCCEDANEUM
- Mechanical trauma of the initial portion of scalp pushing through a narrowed cervix
- Prolonged or difficult delivery
- Vacuum extraction
- Scalp swelling that extends across the midline and over suture lines
- Soft and puffy swelling of part of a scalp in a newborn’s head
- May be associated with increased molding of the head
- The swelling may or may not have some degree of discoloration or bruising
- Needs no treatment. The edema is gradually absorbed and disappears about the third day of life.
- Jaundice – results as the bruise breaks down into bilirubin.
- Rupture of a periostal capillary due to the pressure of birth
- Instrumental delivery
- Swelling of the infant’s head 24-48 hours after birth
- Discoloration of the swollen site due to presence of coagulated blood
- Has clear edges that end at the suture lines
- Observation and support of the affected part.
- Transfusion and phototherapy may be necessary if blood accumulation is significant
- Jaundice
| Difference between a Caput Succedaneum and Cephalhematoma | ||
| INDICATORS | CAPUT SUCCEDANEUM | CEPHALHEMATOMA |
| Location | Presenting part of the head | Periosteum of skull bone and bone |
| Extent of Involvement | Both hemispheres; CROSSES the suture lines | Individual bone; DOES NOT CROSS the suture lines |
| Period of Absorption | 3 to 4 days | Few weeks to months |
| Treatment | None | Support |
Head
The most common findings after birth are caput succedaneum and cephalohematoma. Caput succedaneum is edema of the scalp skin and crosses suture lines. Cephalohematomas are subperiosteal and therefore do not cross suture lines. Frequently, the clinician gains the impression of a depressed skull fracture while palpating the rim of a cephalohematoma. This (false) perception is so common that we do not routinely obtain skull radiographs of an infant with a cephalohematoma unless other worrisome signs are present as well. Rarely, subgaleal hemorrhage may occur, especially after a birth assisted with vacuum extraction. The hemorrhage is under the aponeurosis of the scalp but above the periosteum. The swelling crosses suture lines and can be differentiated from a caput succedaneum on the basis of its firmness and other signs of loss of blood from the intravascular space.
On the first day of life, molding of the head from descent through the birth canal may be present, and the skull plates are overriding. After a few days, the clinician can better estimate the size of the fontanelles, their flatness, fullness, or tenseness, and the width of suture lines (Faix, 1982; Popich and Smith, 1972). Fontanelles may tense normally with vigorous crying. A bulging or tense fontanelle has a feel on palpation nearly equivalent to that of bone. In contrast, a full fontanelle may be normal and is easily distinguished from bone on palpation. The clinician may note the fusion of the sagittal, metopic, or coronal sutures as either total, partial, or unilateral. Large fontanelles and split sutures are most often a normal variant, but they can be associated with increased intracranial pressure or conditions that impair bone growth. Likewise, small fontanelles and overriding sutures are generally of little significance but may be associated with conditions in which brain growth has been retarded (Table 25-10). A small (third) fontanelle anterior to the posterior fontanelle is occasionally found and is associated with Down syndrome and hypothyroidism. Unusual whorls or other hair patterns and asymmetries of the skull may indicate problems in global or regional brain development.
In a Nutshell
- •
Caput succedaneum is edema that resolves in a few days; it crosses the midline.
- •
Cephalohematoma is a subperiosteal collection of blood that does not cross suture lines. It takes several weeks to months to resolve.
- •
Subgaleal hemorrhage presents as a fluctuant mass that crosses suture lines. Blood loss can be extensive and lead to hypovolemic shock.