From the Guidelines
The treatment for a newborn with a head hematoma typically involves supportive care, as surgical evacuation of the hematoma has not been shown to improve outcomes, except in cases of extremely high intracranial pressure 1. The management of a newborn with a head hematoma is primarily focused on monitoring and supportive care.
- Key aspects of care include:
- Monitoring the hematoma for changes in size, color, and the baby's overall condition
- Gentle handling of the affected area to avoid pressure on the swelling
- Pain management, if necessary, with acetaminophen (Tylenol) at a dose of 10-15 mg/kg every 4-6 hours as directed by a healthcare provider
- It is essential to seek medical attention immediately if the baby develops symptoms such as fever, increased irritability, lethargy, poor feeding, or if the swelling rapidly increases in size or spreads, as these could indicate infection or more serious complications 1.
- Surgical intervention, such as ventricular drainage and shunting for progressive hydrocephalus, may be considered in rare cases, but its benefits are not well established for neonates with head hematomas 1.
- Anticoagulation therapy, including unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), is not commonly used in neonates with head hematomas, except in cases of multiple thrombosed sinuses and radiological evidence of propagating thrombosis despite supportive therapy 1.
From the Research
Treatment for Newborn with Head Hematoma
The treatment for a newborn with a head hematoma depends on the severity and location of the hematoma.
- For cases of traumatic epidural hematoma, treatment can be either conservative or surgical, depending on factors such as the neurological status of the infant, the thickness of the hematoma, and the presence of any additional intracranial pathology 2.
- Conservative treatment may be suitable for infants with normal neurological examination, high Children Coma Scale score, hematoma thickness below 20 mm, no apparent shift, and without associated brain pathology 2.
- Surgical treatment may be necessary for infants with thicker hematomas or those who show signs of neurological deterioration 2.
- In some cases, infants with head hematomas may develop chronic subdural hematomas, which require close follow-up and may need to be treated with subduro-peritoneal shunting 3.
- For epidural hematomas in newborns, surgical drainage may be required in some cases, but conservative treatment can also be effective, and the outcome is generally good 4.
Factors Influencing Treatment
Several factors can influence the treatment of a newborn with a head hematoma, including:
- The size and location of the hematoma
- The presence of any additional intracranial pathology
- The neurological status of the infant
- The age of the infant
- The mechanism of injury (e.g. birth trauma, fall)
Importance of Close Monitoring
Close monitoring of infants with head hematomas is crucial to detect any signs of neurological deterioration or development of chronic subdural hematomas 5, 3.