ABSTRACT
To describe the presentation and outcome of infants who develop subgaleal hematoma
(SGH), we compared perinatal factors, clinical and head imaging findings, and outcome
in a cohort (N = 34) of all infants admitted to Saint Louis Children's Hospital neonatal
intensive care unit with SGH from January 1991 to June 2003. All except three of the
infants admitted with SGH had instrumental deliveries (31 of 34; 91.2%): 21 vacuum,
eight vacuum followed by forceps, two forceps). There was also a high frequency of
occurrence of associated intracranial hemorrhage (17 of 34; 50%: subarachnoid hemorrhage,
n = 4; intraventricular hemorrhage, n = 4; intraparenchymal hemorrhage, n = 4; subdural
hemorrhage, n = 11), and skull fracture (six of 34; 19.4%; three of six [50%] of them
depressed fractures). There was mortality associated with SGH (four of 34, 11.8%);
those who died had significant volume loss with anemia, coagulopathy, and shock requiring
large volumes of blood and blood products transfusions. The presence of ICH did not
correlate with the severity of SGH or mortality, but the severity of SGH correlates
with mortality. Minor neurological abnormalities were noted in only four infants at
discharge. In conclusion, SGH is an uncommon type of birth trauma, and is associated
with delivery or attempted delivery by instrumentation (vacuum and/or forceps). Severe
hypovolemia and coagulopathy, but not intracranial hemorrhage, were the most commonly
associated clinical problems with mortality. ICH does not correlate with severity
of SGH. A brain computed tomography or magnetic resonance imaging should be considered
in evaluating a clinically symptomatic SGH. There is associated mortality in severe
cases but short-term outcome in survivors is good.
KEYWORDS
Subgaleal - hematoma - vacuum
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