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CranialComplicationsinNewbornsDavidKuykendall,MDUniversityofNevadaSchoolofMedicine2013...CranialComplicationsinNewbo1LayersofSkull...LayersofSkull...2CephalohematomaHemorrhageofbloodvesselsbetweentheskullandperiosteumofanewbornbaby.MostcommonlythebridgingbloodvesselscrossingtheperiosteumBecausethebleedislimitedtothesubperiostealplane,thebleedislimitedtotheparticularboneofthecraniumThisdoesnotcrosssuturelines...CephalohematomaHemorrhageofb3CausesMostcommonlycausedbyprolongedsecondstageoflaborCommonlycausedduringassistedlabortechniquessuchasvacuum-assistedvaginaldeliveriesMayalsobecommoninlabordystociafrompressureofpresentingpartoftheheadthroughbirthingcanalCanbecausedbyforcep-assistedvaginaldeliveriesbutlesscommoncomparedtovacuumorlabordystocia...CausesMostcommonlycausedby4SymptomsJaundiceAnemiaHypotensionIrritabilityPoorFeeding...SymptomsJaundice...5RisksCephalohematomasmaytakeweekstoresolveasthebabyslowlyresorbsthebloodclotMaymaskanunderlyinglinearskullfractureHighriskformeningitisorosteomyelitisRuleoutsubgalealhemorrhageCoagulopathy?...RisksCephalohematomasmaytake6Cephalohematoma...Cephalohematoma...7SubgalealHemorrhageBleedingbetweentheperiosteumandthescalpgalealaponeurosisEtiologyandsignssimilartoCephalohematomaCrossessuturelines!MaypresentashemorrhagicshockThisareamayholdupto50%ofthebaby’sbloodvolumeCanpresentacrossentirescalp...SubgalealHemorrhageBleedingb8CausesAlmostalwayscausedsolelybyvacuum-assistedvaginaldeliveriesIntensepressurerequiredtocreateseparationbetweenaponeurosisandperiosteumSteadytractionduringvaccum-assisteddeliverieslowersrisk...CausesAlmostalwayscausedsol9ManagementRuleoutCoagulopathyVigilantObservationJaundice,Anemia,Neurologicalsymptoms,VitalsignsNEVERevacuatehematoma:highriskofinfectionAbscess,meningitis,osteomyelitisPhototherapyifjaundicedSkullX-rayorCTtoruleoutfracturesOrderifneurologicalfindingspresentonexamMaytakeacoupleofmonthstoresolvePatienteducation:course,importanceofobservation,anticipatoryguidanceonsignsofinfection,jaundice,orhemorrhage...ManagementRuleoutCoagulopath10SubgalealHemorrhage...SubgalealHemorrhage...11CaputSuccedaneumSerosanguinous,subcutaneous,and/orperiostealfluidcollectionwithpoorlydefinedmarginsBleedingbelowthescalpandabovetheperiosteum...CaputSuccedaneumSerosanguinou12CauseSameasaboveMostcommonlycausedbypressureofpresentingpartofthecraniumpushingagainstthedilatingcervixduringlaborTourniqueteffect...CauseSameasabove...13SignsSimilartoaboveScalpswellingthatextendsoversuturelinesandassociatedwithheadmoldingCommonfindingissuperficialbruising/edemaduetotourniqueteffectandsuperficiallocationUnlikepreviousdisorders,itusuallyisasymptomaticanddoesnotpresentwithsymptomsotherthanscalpswelling...SignsSimilartoabove...14ManagementObservation,Observation,andmoreObservationCommonlyresolveswithinfirstweeksoflifeEducateparentsthatscalpshapeshouldreturntonormalAnticipatoryguidanceonsignstoreturntoER:jaundice,anemia,neurologicalfindings(changeinactivityorfeeding)andsignsofshock...ManagementObservation,Observa15CaputSuccedaneum...CaputSuccedaneum...16ReferencesAAPTextbookofPediatricsDamosJR,BassettR.ChapterH:assistedvaginaldelivery.In:AdvancedLifeSupportinObstetrics(ALSO)ProviderSyllabus.4thed.Leawood,Kan.RonaldS.Gibbs;DavidN.Danforth;BethYKarlan;ArthurFHaney(2008).Danforth'sobstetricsandgynecology.LippincottWilliams&Wilkins.p.
470.RosenbergA.Traumaticbirthinjury.NeoReviews2003;4:270.UpToDate:NeonatalBirthInjuries.Retrieved10-3-2013U.S.FoodandDrugAdministration,CenterforDevicesandRadiologicalHealth.FDApublichealthadvisory:needforCAUTIONwhenusingvacuumassisteddeliverydevices.WenSW,LiuS,KramerMS,etal.Comparisonofmaternalandinfantoutcomesbetweenvacuumextractionandforcepsdeliveries....ReferencesAAPTextbookofPedi17CranialComplicationsinNewbornsDavidKuykendall,MDUniversityofNevadaSchoolofMedicine2013...CranialComplicationsinNewbo18LayersofSkull...LayersofSkull...19CephalohematomaHemorrhageofbloodvesselsbetweentheskullandperiosteumofanewbornbaby.MostcommonlythebridgingbloodvesselscrossingtheperiosteumBecausethebleedislimitedtothesubperiostealplane,thebleedislimitedtotheparticularboneofthecraniumThisdoesnotcrosssuturelines...CephalohematomaHemorrhageofb20CausesMostcommonlycausedbyprolongedsecondstageoflaborCommonlycausedduringassistedlabortechniquessuchasvacuum-assistedvaginaldeliveriesMayalsobecommoninlabordystociafrompressureofpresentingpartoftheheadthroughbirthingcanalCanbecausedbyforcep-assistedvaginaldeliveriesbutlesscommoncomparedtovacuumorlabordystocia...CausesMostcommonlycausedby21SymptomsJaundiceAnemiaHypotensionIrritabilityPoorFeeding...SymptomsJaundice...22RisksCephalohematomasmaytakeweekstoresolveasthebabyslowlyresorbsthebloodclotMaymaskanunderlyinglinearskullfractureHighriskformeningitisorosteomyelitisRuleoutsubgalealhemorrhageCoagulopathy?...RisksCephalohematomasmaytake23Cephalohematoma...Cephalohematoma...24SubgalealHemorrhageBleedingbetweentheperiosteumandthescalpgalealaponeurosisEtiologyandsignssimilartoCephalohematomaCrossessuturelines!MaypresentashemorrhagicshockThisareamayholdupto50%ofthebaby’sbloodvolumeCanpresentacrossentirescalp...SubgalealHemorrhageBleedingb25CausesAlmostalwayscausedsolelybyvacuum-assistedvaginaldeliveriesIntensepressurerequiredtocreateseparationbetweenaponeurosisandperiosteumSteadytractionduringvaccum-assisteddeliverieslowersrisk...CausesAlmostalwayscausedsol26ManagementRuleoutCoagulopathyVigilantObservationJaundice,Anemia,Neurologicalsymptoms,VitalsignsNEVERevacuatehematoma:highriskofinfectionAbscess,meningitis,osteomyelitisPhototherapyifjaundicedSkullX-rayorCTtoruleoutfracturesOrderifneurologicalfindingspresentonexamMaytakeacoupleofmonthstoresolvePatienteducation:course,importanceofobservation,anticipatoryguidanceonsignsofinfection,jaundice,orhemorrhage...ManagementRuleoutCoagulopath27SubgalealHemorrhage...SubgalealHemorrhage...28CaputSuccedaneumSerosanguinous,subcutaneous,and/orperiostealfluidcollectionwithpoorlydefinedmarginsBleedingbelowthescalpandabovetheperiosteum...CaputSuccedaneumSerosanguinou29CauseSameasaboveMostcommonlycausedbypressureofpresentingpartofthecraniumpushingagainstthedilatingcervixduringlaborTourniqueteffect...CauseSameasabove...30SignsSimilartoaboveScalpswellingthatextendsoversuturelinesandassociatedwithheadmoldingCommonfindingissuperficialbruising/edemaduetotourniqueteffectandsuperficiallocationUnlikepreviousdisorders,itusuallyisasymptomaticanddoesnotpresentwithsymptomsotherthanscalpswelling...SignsSimilartoabove...31ManagementObservation,Observation,andmoreObservationCommonlyresolveswithinfirstweeksoflifeEducateparentsthatscalpshapeshouldreturntonormalAnticipatoryguidanceonsignstoreturntoER:jaundice,anemia,neurologicalfindings(changeinactivityorfeeding)andsignsofshock...
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