From the Guidelines
Management of a newborn with overriding sutures typically involves observation and reassurance as this finding is usually normal in the immediate newborn period. Overriding sutures occur when the cranial bones overlap slightly at their junctions due to molding during vaginal delivery. No specific medications or interventions are typically needed. Parents should be educated that this finding typically resolves spontaneously within 24-72 hours as the infant's head shape normalizes.
Key Considerations
- During routine well-child visits, healthcare providers should continue to monitor head circumference and fontanelle size to ensure normal head growth.
- If overriding sutures persist beyond several days, are associated with abnormal head shape, irritability, vomiting, or if the anterior fontanelle is bulging or sunken, further evaluation is warranted to rule out conditions like craniosynostosis or increased intracranial pressure.
- The physiological basis for this approach is that skull molding is a normal adaptation that allows the fetal head to pass through the birth canal, and the newborn skull is designed to gradually return to its normal shape after birth as brain growth continues.
Additional Guidance
- While the provided evidence 1 primarily focuses on the management of neonatal epidermolysis bullosa, the general principles of gentle handling and minimizing trauma can be applied to the care of newborns with overriding sutures.
- However, the specific management of overriding sutures does not require the specialized care outlined in these guidelines, and instead, follows the general principles of observation and reassurance.
- The study on pain management in neonates 1 highlights the importance of considering pain relief in the broader context of neonatal care, but it does not directly apply to the management of overriding sutures, which typically does not involve surgical intervention or significant pain.
From the Research
Management Approach for Newborn with Overriding Sutures
- The management approach for a newborn with overriding sutures involves careful clinical examination and assessment to determine the presence of craniosynostosis or other underlying conditions 2.
- Cranial ultrasound is a reliable first-step imaging technique for diagnosing craniosynostosis in infants, especially those under 6 months of age, and can help avoid unnecessary exposure to ionizing radiation 3.
- In some cases, CT scans may be necessary, but they should be used judiciously due to the risk of radiation exposure, especially in young infants 4.
- The diagnosis of single-suture craniosynostosis can often be achieved through clinical analysis alone, and imaging techniques such as ultrasound or plain radiographs may be used to confirm the diagnosis 4.
- It is essential to differentiate between benign variations of the infant skull, such as overriding sutures, and true craniosynostosis, which requires timely referral to a craniofacial specialist 2.
Diagnostic Considerations
- Cranial ultrasound is a highly specific and sensitive imaging technique for diagnosing craniosynostosis in infants, with a high degree of accuracy when performed by experienced operators 3.
- CT scans and plain radiographs may be used in certain cases, but their use should be carefully considered due to the risk of radiation exposure 4.
- Clinical examination and pattern recognition are essential skills for diagnosing and managing suture-related concerns in infant skulls, and can often facilitate an accurate diagnosis without the need for imaging 2.
Treatment and Follow-up
- The treatment approach for a newborn with overriding sutures will depend on the underlying diagnosis and may involve surgical intervention, such as fronto-orbital advancement, or conservative management with regular follow-up and monitoring 5.
- Children with a history of craniosynostosis repair should be followed for many years to detect delayed closure of cranial sutures and increased intracranial pressure, which may require further surgical intervention 5.