neonatal cranial hematoma
Introduction
Introduction to neonatal head hematoma Head hematoma, often found after birth, may also be apparent after a few days after birth. More common in the top of the skull, the edge of the hematoma is clear, the perimeter does not exceed the suture, the local scalp is normal, and the sense of fluctuation is obvious. When the fetus is quickly forced out of the birth canal, the fetal head is suddenly released by high pressure, causing the subperiosteal vessels to rupture and hemorrhage, and blood accumulates locally to form a hematoma. In addition, fetal head hematoma can sometimes occur in the negative pressure of the fetal head. Generally do not need special treatment, after three or four weeks can absorb and dissipate by themselves, but should pay attention to the scalp clean, avoid squeezing and rubbing, if the hematoma is gradually increased, the local should be pressure bandaged, and add vitamin K, C, etc. Hemostatic drugs. basic knowledge Sickness ratio: 0.05% Susceptible people: children Mode of infection: non-infectious Complications: neonatal hemorrhagic anemia shock shunt hyperbilirubinemia syndrome
Cause
Causes of neonatal head hematoma
(1) Causes of the disease
It is caused by pressure, traction, and midwifery of the fetal head in the birth canal.
1. The head basin is not called or the fetal position is not correct: during the delivery process, the head basin is not called, the fetal position is not correct, and the head is affected by the bony prominence of the birth canal (such as the humerus and pubic symphysis) when the fetal head reaches the pelvic wall.
2. Device midwifery: The forceps are assisted by traction and injured.
3. Prone to cause factors: caused by the body of the fetus, such as low blood prothrombin, poor coagulation function, imperfect development of the elastic wall of the blood vessel wall.
(two) pathogenesis
Hemorrhage and hemostasis of the body is a unity of contradictions. It is a very complicated process, including the rupture and repair of blood vessels, the role of platelets and coagulation substances.
Within 1 week after birth, the neonatal physiologic coagulation factor deficiency and decline period, due to lower factors such as II, VII, IX, X, liver storage of less vitamin K, less synthetic coagulation factors, newborn The vascular wall of the vascular wall is dysplasia, the blood vessel wall is fragile, the capillary permeability of the full-term neonate is twice that of the adult, the premature infant is 6 times that of the adult, and the data of the 807 newborn neonatal platelets measured by Cast1e et al. Platelet reduction, the lowest point after birth is the fourth day, and the recovery on the 10th day is the same as that of the older child, mainly the increase of platelet destruction, which is an intrinsic factor for the easy bleeding of the newborn. In the presence of any factors causing asphyxia such as hypoxia Or under the external conditions such as birth injury, it will increase the destruction of platelets, leading to neonatal bleeding.
Prevention
Neonatal head hematoma prevention
1. Do a perinatal checkup: Make a clear diagnosis before birth to prevent dystocia and surgery.
2. Strengthen the monitoring of labor: find problems in time and take corresponding measures in time.
Complication
Neonatal head hematoma complications Complications neonatal hemorrhagic anemia shock shunt hyperbilirubinemia syndrome
A massive hematoma can cause hemorrhagic anemia, hypovolemic shock, and concurrent hyperbilirubinemia.
Symptom
Neonatal head hematoma symptoms Common symptoms Pale pale newborns eat low blood volume shock head basin does not call circulatory failure head up growth in a tower shape
Most of the children are full-term children, weighing more than 2500g, good at birth, and found a skull mass within a few hours, or found 1 to 4 days after birth.
1. Skull hematoma : also known as subperiosteal hematoma, the tumor is located in the parietal or posterior parietal bone, often located on one or both sides of the top bone, both sides with the same head hematoma or occasional, frontal bone, occipital bone and humerus At the same time, hematoma may occur at the same time. Due to the slow subperiosteal hemorrhage, the hematoma is more obvious in a few hours or 2 to 3 days after birth. The maximum extent is reached within 1 week, and the absorption is gradually reduced. The hematoma is clearly defined and does not cross the suture. There is a sense of fluctuation, the skin color of the local affected area does not change, the skin color of the individual children's hematoma is red, the central part of the swelling is nervous at the beginning, then the top of the swollen part appears to fluctuate, the head hematoma absorbs slowly, because the size can be different in 2 It disappears about 3 months from week to week. When it is absorbed, only the periosteum of the surrounding basement is hard and uneven due to the presence of lime salt. First, a hardened ossified hard edge is formed at the edge of the hematoma, and the central depression is crater-like, and the mass is changed. There are exudates in the body, the length of absorption time varies depending on the size of the mass. The elderly are 3 to 4 months old, and the short ones are about 2 months. The hard and uneven edges of the remains can gradually disappear, but when needed, long.
Sometimes blood passes through the fracture or fissure of the skull, and an intracranial hematoma forms between the skull and the apical membrane. This type of hematoma is small, but it can also oppress the brain and develop brain symptoms.
Individual children have a large head hematoma, affecting the eyelids and forehead, the child appears pale, shock, can die due to sudden circulatory failure, the blood volume of the skull hematoma after death, about 1/3 ~ 1/2 cases up to 100 ~ 150m1 The head hematoma can be aggravated by the decrease in the concentration of blood coagulation factors II, VII, IX, and X.
2. Capular subdural hematoma : shortly after birth, the scalp is limited to swelling. The bleeding can be spread through the soft tissue. When the amount of bleeding is small, the hematoma range is limited. When the amount of bleeding is large, the swelling range is gradually enlarged, which may affect the entire scalp. The amount of the affected area, the eye area, the pillow or the neck and back, the hematoma has a sense of fluctuation, often makes the front sputum difficult to clear, the covered skin can be blue-purple, when the bleeding is severe, it can cause anemia or hypovolemic shock, if not treated in time can cause death.
The extent of hematoma has never crossed the skull, so the periosteum is close to the suture, which is not as easy to separate as it is, and must be distinguished from the meninges and the head.
Infants 1 to 2 days after birth, head hematoma can be hidden under the head of the pioneer, but the vanguard head dissipated after seeing the special fluctuation of hematoma, as the brain swelling and meningocele appear in the cranial suture or cardia, often with breathing Shock, the pressure is small.
After the start of the hematoma, the hard ring around it has been as described above. Because the middle part is soft, it is easy to be mistaken for craniolysis and brain swelling.
Examine
Examination of neonatal head hematoma
1. Blood examination: Red blood cell count can be counted due to blood loss, and the amount of hemoglobin is reduced.
2. Blood biochemical examination: bilirubin increased, mainly indirect bilirubin increased, liver function check was normal.
3. Cranial radiography: The skull hematoma often exists alone, only partial hematoma, for skull imaging, in addition to fractures; meningeal X-ray film of the skull can be seen in the local skull defects can help identify.
4. Skull B-ultrasound and CT examination except for intracranial hemorrhage.
Diagnosis
Diagnosis and diagnosis of neonatal head hematoma
diagnosis
1. Medical history: During the delivery process, there is a head basin not called, the fetal position is not correct, and the forceps assisted the production of traction history.
2. Performance characteristics: occurred 1 to 4 days after birth, the characteristic of the subarachnoid hematoma is that the hematoma occurs between the cap-like aponeurosis and the periosteum of the skull, and the hematoma shrinks and disappears within 2 to 3 days. The area of the head hematoma is mostly at the top, which is more than a few hours to several days after birth. The hematoma is clear, no more than the range of the suture, the center has a sense of fluctuation, no systemic symptoms, and the hematoma subsides slowly.
3. Auxiliary examination: if necessary, take a skull X-ray, or B-ultrasound to help diagnose and differential diagnosis.
Differential diagnosis
1. scalp edema and decidual subdural hematoma: both ranges can exceed the suture, scalp edema is found at birth, the boundaries are not clear, the pressure is soft and concave, no fluctuation, local skin can be red or purple.
2. Meningeal bulging: The head hematoma is located in the occipital region, which needs to be differentiated from the meningeal bulge. The latter has a sensation of swell with the breathing. The skull X-ray film shows a partial skull defect, while the skull hematoma has a complete skull and occasionally a skull-like fracture. .
3. Depression fracture: the skull hematoma is clear, no more than the range of the suture. When the hematoma is absorbed, it is mechanized around the hematoma. The calcification becomes hard and hard, and the center has a sense of fluctuation. It is easily misdiagnosed as a depressed fracture. X-ray The film can be identified.
