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Cephalohematoma in the Newborn

1950; Radiological Society of North America; Volume: 55; Issue: 4 Linguagem: Inglês

10.1148/55.4.503

1527-1315

Michael Ingram, William M. Hamilton,

Fetal and Pediatric Neurological Disorders

Cephalohematoma in the newborn is of common occurrence. Its clinical features are well known, but the roentgenographic changes have received little study, and no reference to this common condition is found in the American radiological literature. Although the clinical diagnosis would seem to be simple, cephalohematoma has been confused with encephalocele and depressed skull fractures. The former diagnosis is usually suggested when the hematoma presents posteriorly in the mid-portion of the occipital bone. A depressed skull fracture is suggested by the presence of a palpable rim of calcium which is found in the early calcifying lesions. It is the purpose of this paper to present the interesting roentgen findings in cephalohematoma of the newborn and to analyze statistically the cases seen at the Vanderbilt University Hospital (Nashville, Tenn.) over a five-year period (1944–49). One of the earliest reports on cephalohematoma was given in 1885 by John M. Keating (4), who accurately postulated that the tumefaction was due to the effusion of blood between the periosteum of the skull and the calvarium itself. Later authors have added little to his fundamental description, but have confined their writings to the incidence and clinical characteristics of the condition. Incidence Sjövall (7) in 1936 reported an incidence of 0.41 per cent in a series of 171 newborn infants. In the present study, a series of 126 cephalohematomata were observed in a total of 7,563 deliveries, an incidence of 1.66 per cent (Table II). Of the 126 cases, 58 involved the right parietal bone, 36 the left parietal bone, 17 were biparietal, and 15 were occipital in origin. None were found in the frontal or temporal bones. The greater number of cephalohematomata occurring in the parietal region is in accord with the previous reports on this subject (7). Etiology Various factors have been suggested as causes of neonatal cephalohematoma. Chief among these is prolonged and difficult delivery. Hartley and Burnett (3) suggested that the fall in infant blood prothrombin seen on the second and third postpartum day might be a factor in the etiology. In the present series of cases, the following factors were considered: birth weight of the infant, sex of the infant, prenatal administration of vitamin K, fetal presentation, maternal parity, and instrumental delivery. A study of the infant birth weight in this series reveals that this factor was of significance in neonatal cephalohematoma. The average weight of newborn infants at the Vanderbilt University Hospital over this period (1944–49) was 7 lb. 5 oz. The average weight of the infants with cephalohematoma was 7 lb. 12 oz. However, when the infants are grouped according to weight and compared with the grouping by weight of a similar series of normal infants, it can be seen that a significant difference exists.