Neonatal Scalp Swelling

SCALP Mnemonic
- Skin
- Connective Tissue
- Aponeurosis (galea)
- Loose areolar connective tissue
- Periosteum

Caput
- subcutaneous edema not blood, usually 2/2 prolonged delivery
- most impressive after birth then resolves over following 1-2 days
- feels like bread dough; not well defined
- crosses suture lines, vague borders, feels doughy, can have pitting edema
- caused by pressure of skull against dilating cervix, increeased with vacuum assisteddelivery,
located at the presenting portion of the skull
- localized soft tissue edema

Cephalohematoma
- very well defined, circumscribed by suture lines
- with birth process, increased risk w/ vacuum
- over first 24HOL, manifests as blood collects
- rarely severe
- caused by birth process or vacuum/forceps assited delivery
- usually over parietal bone
- if large cephalohematoma, risk for calcification

Subgaleal Hematoma
- below galea aponeurosis
- lots of room to grow
- poorly defnied
- presents after birth, progressively worsens
- feels boggy, can have fluid wave, resolves over 2-3 weeks
- associated with coagulopathy
- blood volume may be massive w/ hypovolemic shock
- now clinically diagnosed; risk for litigation with trauma etiology
- can be widespread: from eyes to the nape of the neck, from ear to ear
- Mortality 12-25%
- subgaleal hematomas can hurt
- serial exams, serial HC, serial H/H, +/=

Intracranial bleeds

Ultrasound cannot identify scalp layers, only identifies location

Head CT or MRI more definitively diagnoses subgaleal hematoma

TAKE HOME MESSAGES

- Define location and extent of swelling
- Identify relationship of swelling to sutures
- Think about timing and progression of swelling