Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management

Abstract

Subgaleal haemorrhage (SGH) is an important cause of preventable morbidity and mortality in the neonate. Its increased prevalence in recent years has coincided with the rise in the number of births assisted by vacuum extraction. Three deaths in Australia within the last 7 years have been the subject of two coronial inquests. Subsequent coronial reports have highlighted that neonatal death from SGH can be prevented if appropriate attention is paid to identification of risk factors, early diagnosis, close observation and aggressive treatment. To prevent unnecessary deaths, all involved in the care of the baby after birth need to be aware of the importance of prompt diagnosis, monitoring and early treatment of SGH.

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

“…The general physical condition, as well as the scalp, of neonates exposed to VAD was re‐examined 24 hours after delivery. SGH was diagnosed by an experienced senior neonatologist in accordance with reported guidelines, and as performed in previous studies . In short—diagnosis was made based on physical and sonographic examinations demonstrating the presence of a tender fluctuant scalp swelling, crossing the suture lines of a neonate's skull.…”

“…In short—diagnosis was made based on physical and sonographic examinations demonstrating the presence of a tender fluctuant scalp swelling, crossing the suture lines of a neonate's skull. The degree of SGH was defined as mild, moderate or severe according to published literature and previously accepted criteria . Briefly, SGH severity is determined based upon the degree of head circumference expansion, hyperbilirubinemia and the therapy required to treat the hypovolemic shock.…”

“…SGH was diagnosed by an experienced senior neonatologist in accordance with reported guidelines, and as performed in previous studies. 4,9,11,13,22 In short-diagnosis was made based on physical and sonographic examinations demonstrating the presence of a tender fluctuant scalp swelling, crossing the suture lines of a neonate's skull. The degree of SGH was defined as mild, moderate or severe according to published literature and previously accepted criteria.…”

“…The degree of SGH was defined as mild, moderate or severe according to published literature and previously accepted criteria. 4,22,23 Briefly, SGH severity is determined based upon the degree of head circumference expansion, hyperbilirubinemia and the therapy required to treat the hypovolemic shock.…”

Untitled

“…The spectrum of clinical severity varies from mildly asymptomatic to severe, with hemorrhagic shock, coagulopathy and end organ injury. Early recognition of symptoms, prompt restoration of circulatory volume and control of bleeding could improve outcomes [1].…”