Intracranial hemorrhage in infants with cephalohematoma

• Published in: Pediatrics international Vol. 56; no. 3; pp. 378 - 381
• Main Authors: Kim, Heng Mi, Kwon, Soon Hak, Park, Sook Hyun, Kim, Yong Sun, Oh, Ki Won
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-06-2014
• Subjects: Babies; Brain Diseases - complications; cephalohematoma; Cerebral Hemorrhage - complications; epidural hemorrhage; Hematoma - complications; Hemorrhage; Humans; Infant; intracranial hemorrhage; Intracranial Hemorrhages - complications; Medical imaging; Neuroimaging; Neurological disorders; newborn; Pediatrics; Retrospective Studies; skull fracture; subdural hemorrhage; subdural hemorrhage; newborn; intracranial hemorrhage; epidural hemorrhage; skull fracture; cephalohematoma
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.12255

Background
Intracranial hemorrhage (ICH) is a rare birth injury in term infants. Newborn infants with cephalohematoma (CH) associated with ICH, however, have frequently been found incidentally at Kyungpook National University Hospital; many of them had no neurological symptoms. The aim of this study was to evaluate the clinical manifestations of ICH in newborn infants with CH.
Methods
Newborn infants with CH in the neonatal intensive care unit were retrospectively evaluated. During period I (5 years), neuroimaging (brain computed tomography and magnetic resonance imaging) was performed when intracranial abnormalities were suspected. During period II (36 months) neuroimaging was performed when CH > 5 cm in diameter was present.
Results
During period I, seven out of 19 infants who underwent neuroimaging had ICH (36.8%) including two epidural hemorrhages (EDH). During period II, 18 out of 27 infants who underwent neuroimaging had ICH (66.7%), including two EDH. There was no significant difference in the clinical manifestations between infants with and without ICH. In 10 cases of CH accompanied with a linear skull fracture, nine had ICH, including all cases of ICH that needed intervention.
Conclusions
The association of ICH appears to be common in newborn infants with CH; particularly in infants with CH accompanied with a skull fracture, the rate of ICH was very high, and all cases of EDH requiring intervention were associated with skull fracture. Therefore, evaluation of accompanying skull fracture should be required in infants with CH, and, in cases of skull fracture, neuroimaging should be considered.