Cranial Complications in Newborns：新生儿颅内并发症.pptVIP

Cranial Complications in Newborns David Kuykendall, MD University of Nevada School of Medicine 2013 Layers of Skull Cephalohematoma Hemorrhage of blood vessels between the skull and periosteum of a newborn baby. Most commonly the bridging blood vessels crossing the periosteum Because the bleed is limited to the subperiosteal plane, the bleed is limited to the particular bone of the cranium This does not cross suture lines Causes Most commonly caused by prolonged second stage of labor Commonly caused during assisted labor techniques such as vacuum-assisted vaginal deliveries May also be common in labor dystocia from pressure of presenting part of the head through birthing canal Can be caused by forcep-assisted vaginal deliveries but less common compared to vacuum or labor dystocia Symptoms Jaundice Anemia Hypotension Irritability Poor Feeding Risks Cephalohematomas may take weeks to resolve as the baby slowly resorbs the blood clot May mask an underlying linear skull fracture High risk for meningitis or osteomyelitis Rule out subgaleal hemorrhage Coagulopathy? Cephalohematoma Subgaleal Hemorrhage Bleeding between the periosteum and the scalp galeal aponeurosis Etiology and signs similar to Cephalohematoma Crosses suture lines! May present as hemorrhagic shock This area may hold up to 50% of the baby’s blood volume Can present across entire scalp Causes Almost always caused solely by vacuum-assisted vaginal deliveries Intense pressure required to create separation between aponeurosis and periosteum Steady traction during vaccum-assisted deliveries lowers risk Management Rule out Coagulopathy Vigilant Observation Jaundice, Anemia, Neurological symptoms, Vital signs NEVER evacuate hematoma: high risk of infection Abscess, meningitis, osteomyelitis Phototherapy if jaundiced Skull X-ray or CT to rule out fractures Order if neurological findings present on exam May take a couple of months to resolve Patient education: course, importance of observation, anticipatory guid