From the Research
A large cephalohematoma is typically considered to be one that measures greater than 9 mm in maximal projection, as defined by ultrasound measurements, or extends over a significant portion of the skull. Cephalohematomas are collections of blood between the skull bone and its periosteum (outer covering), commonly occurring in newborns as a result of birth trauma 1. The size classification is important because larger cephalohematomas may take longer to resolve (sometimes 3-6 months) and have a higher risk of complications such as anemia, jaundice, or rarely, infection. Some key points to consider include:
- Most cephalohematomas resolve spontaneously without treatment, but large ones require closer monitoring 2, 1.
- Parents should watch for signs of increasing size, redness, warmth, or fever which might indicate infection 3.
- Large cephalohematomas should not be drained due to infection risk unless absolutely necessary under sterile conditions by a specialist 1, 3.
- The underlying physiology involves blood vessels crossing from the periosteum to the skull being torn during birth trauma, with blood accumulating in this potential space and creating a firm, non-pulsatile swelling that doesn't cross suture lines of the skull 4.
- Early needle aspiration of large infant cephalohematoma can be a safe procedure to avoid aesthetic complications, and can be performed between 15 and 30 days after birth 1.