Cephalohematoma

What is cephalohematoma?

Cephalohematoma (seh-FEL-low HE-muh-toe-muh) is blood that collects between a newborn’s scalp and skull. Hematoma means blood that pools outside blood vessels. Cephalo refers to the head.

This type of birth injury occurs when pressure on a baby’s head ruptures blood vessels in the scalp. The blood pools beneath the scalp, forming a soft bulge that eventually hardens.

How common is cephalohematoma?

Cephalohematomas occur in about 2.5% of prolonged, difficult vaginal deliveries. An assisted delivery that requires vacuum extraction or forceps raises the risk to about 1 baby in 10 delivered this way.

What are risk factors for cephalohematoma?

These factors increase the risk of a newborn having cephalohematoma:

• Assisted delivery using vacuum extraction or forceps.
• Epidural pain relief during childbirth.
• Larger-than-average baby (fetal macrosomia) weighing more than 8 pounds 13 ounces.
• Multiple babies (twins, triplets or more).
• Prolonged, difficult vaginal delivery.

What are the effects of cephalohematoma?

Pressure on a newborn’s scalp during childbirth can damage or rupture tiny blood vessels in the scalp. Blood collects under the scalp, causing a soft bulge or bump to form, typically on the back of the head. This bulge appears soon after birth and may grow in size for a few days. It may look like a bruise.

Over time, the soft mass starts to harden or calcify. The lump often shrinks in the center first, which can cause it to have a ring-shaped or crater-like appearance.

What should I expect if my baby has cephalohematoma?

Cephalohematoma is often harmless. The bruising or blood buildup should go away without treatment in a couple of weeks or months.

What are the potential complications of cephalohematoma?

Potential complications of cephalohematoma include:

• Anemia: A cephalohematoma takes blood away from the baby’s circulatory system. This can lead to anemia (low red blood cell count). A larger cephalohematoma is more likely to cause anemia.
• Calcifications: Cephalohematomas that last more than five weeks may form hardened bone deposits (calcifications) around the mass. This rare problem can affect skull formation. Babies need corrective surgery to remove calcification.
• Infections: A cephalohematoma is more prone to infections. In rare instances, it may lead to life-threatening osteomyelitis (bone infection), cellulitis or sepsis.
• Jaundice: As a baby’s body absorbs the blood from the cephalohematoma, bilirubin levels in the bloodstream can rise, causing jaundice. Your baby may have a yellow tint to their skin or eyes.
• Skull fractures: As many as 1 in 4 babies with cephalohematomas also have a linear skull fracture. While this might sound alarming, this type of bone fracture doesn’t move the bones in the skull. A linear skull fracture will heal over time without treatment.

What is the difference between cephalohematoma and caput succedaneum?

Cephalohematoma and caput succedaneum (also called caput or newborn conehead) may occur together or separately. Both conditions often go away without treatment.

• Cephalohematoma is a buildup of blood (hemorrhage) underneath a newborn’s scalp. It appears soon after birth. The bulge is discrete, does not cross the suture lines of the bones on their head, and is located at the back of the head. It may take months to go away.
• Caput succedaneum causes swelling (edema) on the top of the scalp that is usually noticeable at birth. This swelling causes the scalp to feel spongy, does cross suture lines, and starts to go down soon after birth.

A note from Cleveland Clinic

Having a newborn with a bruised-looking lump on their scalp can be concerning, but cephalohematomas are generally harmless. This lump should get smaller and go away in a few weeks or months without treatment. Your child’s healthcare provider will keep an eye on the bump at your baby’s newborn visits. Cephalohematomas do increase a baby’s risk of jaundice, anemia and infections. In rare instances, a newborn may also have a skull fracture that should heal on its own. You should contact your child’s healthcare provider if your baby is extremely fussy, shows signs of jaundice or refuses to eat or sleep.