Subgaleal hemorrhage is a rare yet serious condition that can affect newborns, involving bleeding in the space between the scalp and the skull. This can lead to rapid and significant blood loss. Recognizing the signs and understanding the medical response is important for ensuring the best possible outcomes.
What is Subgaleal Hemorrhage?
Subgaleal hemorrhage refers to bleeding that accumulates in the subgaleal space, a potential space between the galea aponeurotica (a fibrous layer covering the top of the skull) and the skull’s periosteum. This anatomical location allows for a large volume of blood to collect, as the space is not confined by bone sutures. It can potentially hold up to 40% of a newborn’s total blood volume.
Because of this large capacity, significant blood loss can occur quickly, leading to serious complications such as hemorrhagic shock. This condition differs from other common newborn head swellings like caput succedaneum, a diffuse scalp swelling that crosses suture lines and is typically benign, or cephalohematoma, a blood collection under the periosteum confined by suture lines.
Identifying the Signs
Parents or caregivers may observe several signs if a newborn has a subgaleal hemorrhage. A palpable swelling on the head is a key sign, feeling soft and “boggy” to the touch. This swelling may expand over time as more blood accumulates and can shift with movement. Unlike some other head swellings, this swelling can cross cranial suture lines.
Along with scalp swelling, the infant may exhibit signs of blood loss. These can include pallor, indicating a pale skin tone, and lethargy, meaning the baby appears unusually sleepy or unresponsive. Poor feeding can also be observed.
More concerning signs involve changes in vital signs, such as an increased heart rate (tachycardia) and a decrease in blood pressure. In severe cases, signs of shock, such as very low blood pressure and diminished muscle tone, may develop. The rapid appearance or worsening of these signs warrants immediate medical attention.
Common Causes and Risk Factors
Subgaleal hemorrhages are linked to trauma during labor and delivery. A primary cause involves the severing of veins connecting the scalp to the baby’s sinuses. This often occurs when there is pulling, dragging, or compressing of the baby’s head as it moves through the birth canal.
Assisted vaginal deliveries, specifically those involving vacuum extractors or forceps, are recognized as risk factors. The application of a vacuum extractor can pull the scalp away from the skull, loosening connective tissue and allowing blood to gather. Other contributing factors include prolonged or difficult labor, large birth weight (macrosomia), and prematurity, as premature infants have more fragile blood vessels. Certain bleeding disorders (coagulopathy) can also increase the likelihood of hemorrhage.
Medical Diagnosis and Treatment
Medical professionals diagnose subgaleal hemorrhage through a combination of physical examination findings and diagnostic imaging. A soft, boggy scalp and expanding head circumference are physical signs that prompt further investigation. Doctors monitor vital signs hourly and serially assess hematocrit levels to detect blood loss.
Head imaging, such as an ultrasound or CT scan, helps differentiate subgaleal hemorrhage from other types of cranial bleeding. An ultrasound of the head is often the initial imaging choice due to its non-invasive nature, while a CT scan provides more detailed anatomical information. Once diagnosed, medical management focuses on supportive care and addressing the consequences of blood loss. This often involves fluid resuscitation using intravenous fluids like normal saline to restore blood volume.
If blood loss is significant, blood transfusions may be necessary to correct anemia and maintain adequate oxygen-carrying capacity. Close monitoring of vital signs, blood counts, and bilirubin levels is continuous to manage potential complications. Hyperbilirubinemia, a buildup of bilirubin from the breakdown of red blood cells, is a common complication that may require phototherapy. Management also includes addressing hypovolemic shock, a serious condition resulting from severe fluid and blood loss.
Navigating Recovery
The recovery process for a newborn after a subgaleal hemorrhage involves several weeks, with swelling gradually resolving as the body reabsorbs the accumulated blood. Close monitoring continues during this period to ensure there are no lingering complications. Medical staff will continue to track the baby’s vital signs and head circumference to confirm the bleeding has stopped and the swelling is decreasing.
Follow-up appointments with pediatricians and specialists are important to assess the infant’s overall development and ensure complete recovery. The prognosis for newborns with subgaleal hemorrhage is good when the condition is identified early and managed promptly. While some infants may experience complications like anemia or jaundice during the acute phase, long-term consequences are uncommon with timely and appropriate medical intervention.