A 1-day-old boy is evaluated in the neonatal intensive care unit. The patient was born at 34 weeks gestation to a 25-year-old-primigravida after she underwent an induction for preeclampsia with severe features. The delivery was complicated by placental abruption, and a forceps-assisted vaginal delivery was performed due to an abnormal fetal heart rate tracing. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. Examination shows a comfortable, sleeping infant under a radiant warmer with a nasal cannula in place. There is a firm, well-demarcated swelling on the right parietal scalp with no discoloration or apparent tenderness. The remainder of the head and neck examination is unremarkable. The abdomen is soft with no organomegaly. Which of the following is the most likely cause of this patient's physical examination findings?

Question

A 1-day-old boy is evaluated in the neonatal intensive care unit.  The patient was born at 34 weeks gestation to a 25-year-old-primigravida after she underwent an induction for preeclampsia with severe features.  The delivery was complicated by placental abruption, and a forceps-assisted vaginal delivery was performed due to an abnormal fetal heart rate tracing.  Apgar scores were 5 and 8 at 1 and 5 minutes, respectively.  Examination shows a comfortable, sleeping infant under a radiant warmer with a nasal cannula in place.  There is a firm, well-demarcated swelling on the right parietal scalp with no discoloration or apparent tenderness.  The remainder of the head and neck examination is unremarkable.  The abdomen is soft with no organomegaly.  Which of the following is the most likely cause of this patient's physical examination findings?

Quizplus · Accepted Answer

11ec25c8_d6fc_2b6a_bc81_df4702be46f6_MD0003_00 Cephalohematoma is a subperiosteal hemorrhage that occurs due to rupture of subperiosteal blood vessels during delivery. Blood collects between the skull and the periosteum but is limited to the surface of a single cranial bone. Forceps or vacuum-assisted deliveries increase the risk of cephalohematoma. subperiosteal hemorrhage Because subperiosteal bleeding occurs slowly, swelling is often not visible until several hours after birth, as in this patient. Examination reveals nontender, firm, well-demarcated scalp swelling that does not cross suture lines. The overlying skin usually appears normal. The diagnosis is clinical. Management is with reassurance and observation because most cephalohematomas resorb spontaneously within a month. Acute complications include hyperbilirubinemia due to red blood cell breakdown and, rarely, infection. Although also rare, calcification and ossification of large cephalohematomas can occur and lead to skull deformity. (Choice A) Caput succedaneum is a benign scalp swelling superficial to the periosteum that is present at birth and usually involves the portion of the head presenting during a vertex delivery. Unlike in this patient, examination reveals boggy, poorly demarcated edema that crosses suture lines. Caput succedaneum (Choice C) Hydrocephalus (ie, excessive cerebrospinal fluid within the brain) in infants presents with a rapidly enlarging head circumference, often with a wide, bulging anterior fontanelle. Localized scalp swelling would not be seen. Hydrocephalus (Choice D) Positional plagiocephaly (ie, abnormal skull flattening) is most commonly caused by supine positioning of young infants (not newborns). Congenital plagiocephaly may be due to abnormal closure of sutures (ie, craniosynostosis). Neither condition presents with a well-demarcated scalp swelling. (Choice E) Subgaleal hemorrhage is a life-threatening injury characterized by blood collection (potentially massive) between the periosteum and galea aponeurotica due to shearing of emissary veins during delivery. In contrast to cephalohematoma, subgaleal hemorrhage presents with a fluctuant scalp swelling that expands with time and crosses suture lines. Subgaleal hemorrhage Educational objective: Cephalohematoma is a subperiosteal hemorrhage that presents in the first day of life with a firm, well-demarcated scalp swelling that does not cross suture lines. Forceps- or vacuum-assisted deliveries increase the risk of developing cephalohematomas. Management is with observation because most resorb spontaneously. References: Cephalohematoma. (http://www.ncbi.nlm.nih.gov/pubmed/29262234)

A 1-Day-Old Boy Is Evaluated in the Neonatal Intensive Care