Management of Cephalhaematoma in Newborns
Primary Recommendation
Most cephalhaematomas require only observation and supportive care, as they typically resolve spontaneously within 2-8 weeks without intervention. 1, 2, 3
Initial Assessment and Risk Stratification
When evaluating a newborn with cephalhaematoma, immediately assess for:
- Signs of infection: Secondary enlargement, erythema, fluctuance, skin lesions, or systemic fever 1, 4
- Risk factors for infection: Instrumental delivery (forceps/vacuum), scalp electrodes, prolonged rupture of membranes, skin abrasions, or concurrent sepsis 1
- Size and progression: Document baseline size and monitor for expansion 3, 5
- Associated complications: Anemia, jaundice from hemolysis, or underlying skull fracture 1
Conservative Management (Standard Approach)
For uncomplicated cephalhaematomas without signs of infection, observation alone is appropriate. 1, 2, 3
Key Management Points:
- Do NOT aspirate uncomplicated cephalhaematomas, as aspiration increases infection risk 1, 3
- Monitor for spontaneous resolution over 2-8 weeks 3
- Reassure parents this is a benign, self-limiting condition 2
- Follow up clinically to ensure progressive reduction in size 5
Expected Natural History:
- Most resolve completely within 1 month 2, 3
- If persisting beyond 1 month, calcification typically begins 2, 3
- Ossified cephalhaematomas may undergo spontaneous remodeling over months 2
Management of Suspected Infected Cephalhaematoma
If infection is suspected (fever, enlargement, local inflammation, or persistent systemic signs), perform diagnostic aspiration immediately. 1, 4
Diagnostic Approach:
- Obtain blood cultures and inflammatory markers (CBC, CRP) 1, 4
- Perform diagnostic tap of the cephalhaematoma for culture and sensitivity 1, 4
- Most common pathogens: Escherichia coli and Staphylococcal species 1, 4
- Consider imaging (ultrasound or CT) if diagnosis unclear 1
Treatment Protocol for Infected Cephalhaematoma:
- Initiate IV antibiotics immediately after obtaining cultures 1, 4
- Therapeutic aspiration for both diagnosis and drainage 4, 3
- Surgical evacuation and debridement if:
- Continue IV antibiotics for 10 days to 6 weeks depending on clinical response 4
Critical caveat: Even culture-negative cephalhaematomas may require surgical evacuation if systemic signs of infection persist despite antibiotics, as the collection itself can serve as a nidus for inflammation. 4
Surgical Management of Persistent/Ossified Cephalhaematoma
Early surgical intervention (before complete ossification) is indicated for cephalhaematomas that fail to resolve or cause significant cosmetic deformity. 5
Indications for Surgery:
- Persistent enlargement beyond 1-2 months 3, 5
- Early calcification with cosmetic concerns 5
- Secondary craniosynostosis 2
- Significant disfigurement affecting appearance 2, 5
Surgical Timing:
- Early surgery (before complete ossification) allows preservation of underlying calvarium and avoids need for cranioplasty 5
- For simple ossified lesions without cosmetic issues, conservative management remains acceptable 2
- Delayed surgery after complete ossification may require cranioplasty for skull defects 5
Surgical Technique:
- Evacuation of hematoma contents 3, 5
- Removal of calcified membrane if present 5
- Head wrapping post-procedure for non-calcified lesions 3
Common Pitfalls to Avoid
- Never aspirate uncomplicated cephalhaematomas prophylactically—this converts a benign condition into one at risk for infection 1, 3
- Do not dismiss persistent fever in an infant with cephalhaematoma—the collection may be infected even with negative initial cultures 4
- Avoid delaying surgical evaluation if calcification develops and cosmetic concerns exist—early intervention yields better outcomes without need for cranioplasty 5
- Do not assume all persistent cephalhaematomas will calcify—some large chronic lesions remain fluid and may benefit from aspiration 3