Infected cephalohematomas and underlying osteomyelitis: a case-based review

Abstract

When an infected cephalohematoma is suspected, aspiration of hematoma fluid should be performed for both diagnostic and therapeutic purposes. Infectious symptoms should warrant prompt investigation and treatment, which may include drainage, debridement, and antibiotics. This report demonstrates that the combination of an infected cephalohematoma and underlying osteomyelitis might not be as uncommon as previously believed.

Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

“…Scalp hematomas occur in up to 4% of vacuum or forceps deliveries, but only in rare cases scalp hematomas become infected, most commonly by E-coli, Staphylococcus and Streptococcus species [9, 10]. Infected scalp hematomas may occur more often after needle aspiration, fetal monitoring, and instrumental delivery, as in our patient.…”

“…Infected scalp hematoma should be suspected with increasing scalp hematoma, erythema, fluctuation, and relapse of a systemic infection. Clear signs of abscess in the scalp should be treated with incision, aspiration, antibiotics covering the most common microbes present in scalp hematomas, and often followed by surgical debridement [9, 10]. On day 2 our patient developed a scalp hematoma with no early signs of infection.…”

Newborn with spontaneous rupture of an infected cephalohematorma

“…Stuadt et al found only 17 cases of osteomyelitis in 81 total cases of infected cephalohematomas. 6 It is hypothesized that cephalohematomas can become infected via different routes. Hematogenous spread is believed to be causative in many cases.…”

Neonatal Osteomyelitis

“…Pathophysiology. Osteomyelitis in neonates is usually due to hematogenous spread of bacterial infections or less frequently to direct inoculation as a result of a trauma or puncture wounds or surgery, infected cephalohematoma [14][15][16]. In preterm infants, direct injection of bacteria can result from heel or venipuncture and artery or vein umbilical catheterization.…”