Cephalhematoma puncture

Cephalhematoma is a common condition associated with childbirth, occurring in approximately 1-2% of newborns. It appears as a soft, swollen bulge on the child’s head caused by the rupture of blood vessels between the skull bone and its covering tissues (periosteum). In most cases, the formation resolves spontaneously within a few weeks or months, but sometimes medical intervention is required. At "Dobrobut" Medical Center, experienced pediatricians and neonatologists conduct comprehensive diagnostics and, if necessary, offer a procedure such as puncture of the cephalhematoma in newborns, combining the latest techniques and compassionate care to ensure the best results.

When to Seek Medical Attention

Parents should seek medical help at "Dobrobut" if they observe:

• A soft, protruding formation on the newborn’s head, usually limited to one side of the skull and not crossing the midline or sutures.
• Increased swelling or lack of improvement over two weeks: while some growth in the first few days is normal, continued expansion or absence of improvement may indicate the need for intervention.
• Signs of infection, such as redness, increased body temperature, or fever.
• Jaundice (yellowing of the skin and eyes): large cephalhematomas can sometimes lead to jaundice due to the breakdown of red blood cells and increased bilirubin levels.

• Irritability or changes in feeding habits: these symptoms may indicate discomfort or other issues related to the cephalhematoma.
• Visible skull deformation or asymmetry.
• Symptoms of anemia: rarely, but a very large hematoma can cause anemia, leading to paleness and lethargy.

Indications and Contraindications for Cephalhematoma Puncture

Indications include:

• Large hematomas (usually >5 cm in diameter) that show no signs of spontaneous resolution after 3-4 weeks.
• Rapidly growing hematomas that may cause significant pressure on the skull.
• Hematomas causing visible deformation or asymmetry of the skull.
• Cases with a high risk of infection.
• Prolonged jaundice or anemia associated with the hematoma.
• Hematomas causing significant discomfort or interfering with feeding or sleep.

Contraindications

Puncture is not performed if the cephalhematoma is small, asymmetrical, and tends to resolve on its own within a few weeks. The procedure may also be risky if there are bleeding disorders, coagulopathies, or signs of intracranial hemorrhage. Premature babies and newborns with infectious scalp lesions are at higher risk.

Diagnosis

To confirm the need for puncture and ensure a safe approach, the doctor may order a comprehensive examination, which includes:

• Physical examination, during which the pediatrician carefully assesses the size, consistency, and boundaries of the cephalhematoma, and checks for any signs of infection or hidden fractures.
• Ultrasound examination: a non-invasive method that allows determination of the volume and size of the hematoma, its structure, and detection of any potential complications.
• Blood tests: Complete blood count to check for anemia or signs of infection, coagulation tests, bilirubin levels if jaundice is present.

If necessary, additional imaging methods such as X-rays, CT scans providing detailed images of the skull and brain, or MRI, if brain injuries are suspected, may be prescribed.

Preparation

Before the cephalhematoma puncture procedure, the affected area of the scalp is thoroughly cleaned.

Local anesthetics in the form of cream or injections are used for anesthesia.

How the Procedure is Performed

Puncture of the cephalhematoma in newborns is performed to relieve pressure, typically taking 10 to 30 minutes and includes the following steps:

1. Assessment of the Hematoma: The doctor performs a final check of the cephalhematoma and surrounding area.
2. Needle Insertion: A small, sterile needle (typically 18-22 gauge) is carefully inserted into the center of the hematoma. The insertion is done slowly and controlled to minimize discomfort.
3. Blood Aspiration: Using a syringe attached to the needle, the doctor slowly aspirates the accumulated blood, measuring and recording the quantity.
4. Complete Drainage: As much fluid as possible is gradually removed without damaging adjacent tissues. Gentle pressure may be applied during aspiration to collapse the hematoma cavity.
5. Completion of the Procedure: The needle is carefully withdrawn, and the puncture site is closed with a soft dressing. The area of the cephalhematoma is examined post-puncture to ensure proper reduction and absence of early complications.

Recovery

After the puncture of the cephalhematoma, specialists ensure comprehensive care and further monitoring of the child. The newborn remains under observation for an hour with regular checks of vital signs. Immediate feeding is possible to calm the baby and ensure adequate hydration. The bandage should remain dry and clean for 24-48 hours and can be changed if necessary. Parents receive detailed home care instructions, including bathing, sleeping positions, and signs to watch for. A follow-up examination is scheduled in 3-7 days.

Complications

Provided the technique is followed, puncture of a hematoma is considered a fairly safe procedure. Potential complications include infection, reaccumulation of blood, scarring, pain or discomfort, and bleeding. Our specialists take all precautions to minimize these risks, using advanced methods, maintaining stringent sterility standards, and ensuring thorough post-procedure care.

Prevention

The risk of developing cephalhematoma can be reduced by taking these measures:

• Regular prenatal care helps to identify potential complications early.
• Careful obstetric techniques: using gentle natural birthing methods to minimize trauma and wisely employing assistive devices when necessary.
• Proper positioning during childbirth for easy passage through the birth canal.
• Continuous fetal monitoring during labor to promptly identify any signs of distress that may require intervention.
• Assessing the mother’s pelvic size to detect potential disproportion for planning an appropriate birthing method.
• Post-birth care for the newborn and proper head support immediately after birth.
• Immediate medical consultation for any suspicion of cephalhematoma or other birth-related injuries.

At "Dobrobut" Medical Center, the importance of newborn care is well understood especially in cases of cephalhematoma formation. Therefore, all necessary conditions for diagnosis and puncture are offered, utilizing modern protocols and adhering to international guidelines.