Subgaleal Hemorrhage in Newborns: Symptoms, Causes, Treatment

What are the symptoms of a subgaleal hemorrhage in a newborn?

A subgaleal hemorrhage in a newborn is a type of bleeding that occurs between the galea aponeurotica (a thick connective tissue layer covering the skull) and the periosteum (the membrane covering the bones of the skull). This type of hemorrhage can be serious and requires prompt medical attention. Symptoms may include:

Visible Signs

Head Swelling: Noticeable swelling of the newborn’s head, which can expand rapidly and may be more pronounced in the areas above the ears and around the forehead.
Bruising: Possible bruising on the scalp or along the forehead.

Behavioral and Physical Symptoms

Lethargy: Reduced activity levels or excessive drowsiness.
Irritability: Increased fussiness or signs of discomfort.
Poor Feeding: Difficulty with feeding or poor appetite.
Seizures: In some cases, seizures or abnormal movements.

Other Symptoms

Increased Head Circumference: Rapid increase in head size, which may be noticeable during routine check-ups.
Abnormal Bulging: Bulging or tense fontanelles (the soft spots on the baby’s head) that may be more pronounced than usual.

Serious Signs

Signs of Shock: Pale skin, rapid heartbeat, or low blood pressure may indicate a more severe hemorrhage affecting overall health.
Neurological Symptoms: Any signs of altered consciousness, unusual movements, or abnormal responses could indicate more significant neurological impact.

Subgaleal hemorrhage can be caused by trauma during delivery, such as the use of forceps or vacuum extraction, and can lead to significant complications if not managed promptly. If any symptoms are observed, immediate medical evaluation is necessary to assess the extent of the hemorrhage and initiate appropriate treatment.

What are the causes of a subgaleal hemorrhage in a newborn?

A subgaleal hemorrhage in a newborn is caused by bleeding between the galea aponeurotica (the thick connective tissue covering the skull) and the periosteum (the membrane covering the skull bones). Common causes include:

1. Obstetric Trauma

Forceps Delivery: The use of forceps during delivery can cause trauma to the baby’s head and lead to a subgaleal hemorrhage.
Vacuum Extraction: The use of a vacuum device to assist with delivery can create suction and pressure that may result in bleeding in the subgaleal space.

2. Prolonged Labor

Extended Labor: Prolonged or difficult labor can increase the risk of head trauma and subsequent bleeding in the subgaleal space.

3. Delivery Complications

Shoulder Dystocia: Difficulty with the baby’s shoulders during delivery can cause excessive traction and trauma, leading to bleeding.
Head Presentation: Malpresentation of the baby’s head, such as an abnormal position or presentation, can contribute to injury and hemorrhage.

4. Birth Weight

Large For Gestational Age: Newborns who are larger than average for their gestational age are at higher risk for birth trauma and subgaleal hemorrhage.

5. Maternal Factors

Maternal Health Conditions: Certain maternal health conditions or complications during pregnancy may increase the risk of birth trauma and bleeding.

6. Instrumental Delivery

Use of Instruments: Use of delivery instruments, such as forceps or vacuum extractors, can cause trauma and lead to subgaleal hemorrhage.

7. Trauma During Delivery

Head Trauma: Any direct trauma to the baby’s head during delivery, whether from instruments or excessive manipulation, can cause a subgaleal hemorrhage.

8. Coagulation Disorders

Blood Disorders: Although less common, certain blood disorders in the newborn or maternal anticoagulant therapy can contribute to bleeding tendencies.

Subgaleal hemorrhage is a serious condition that requires prompt medical attention to manage and prevent complications. If suspected, immediate evaluation and intervention are crucial to address the extent of the hemorrhage and provide appropriate care.

What is the treatment for a subgaleal hemorrhage in a newborn?

The treatment for a subgaleal hemorrhage in a newborn depends on the severity of the hemorrhage, the symptoms present, and the overall health of the infant. The primary goals are to manage the bleeding, prevent complications, and support the baby’s recovery. Treatment options include:

1. Monitoring and Assessment

Regular Monitoring: Close observation of the newborn’s head circumference, neurological status, and overall condition is essential. This may involve frequent physical exams and measurements.
Imaging Studies: Ultrasound or other imaging techniques may be used to assess the extent of the hemorrhage and monitor changes over time.

2. Supportive Care

Fluid Management: Intravenous fluids may be administered to prevent dehydration and support blood volume.
Nutritional Support: Ensuring the newborn is feeding well and receiving adequate nutrition is important for recovery.

3. Medical Management

Pain Relief: Pain management may be provided to ensure the newborn is as comfortable as possible.
Monitoring for Complications: Watch for signs of complications such as increased intracranial pressure or anemia.

4. Surgical Intervention

Surgical Drainage: In severe cases where there is significant bleeding or pressure on the brain, surgical intervention may be required to drain the hemorrhage and relieve pressure. This is usually done by a pediatric neurosurgeon.

5. Treatment of Underlying Conditions

Addressing Trauma: Managing any underlying causes of trauma, such as addressing complications from delivery.
Managing Coagulation Issues: If a blood disorder or coagulation issue is present, specific treatments to address these conditions may be necessary.

6. Long-Term Follow-Up

Developmental Monitoring: Regular follow-up appointments to monitor the baby’s development and neurological status.
Rehabilitation: Depending on the extent of any developmental or neurological impact, physical therapy or other forms of rehabilitation may be recommended.

7. Parental Support

Education and Support: Providing parents with information about the condition, treatment plan, and what to expect during recovery.

Timely and appropriate management is crucial to improve outcomes and prevent long-term complications. If a subgaleal hemorrhage is suspected, prompt medical evaluation and intervention are essential to ensure the best possible care for the newborn.