Kefalogematoma – a patrimonial trauma which is characterized by a blood congestion between a bone of a skull and a periosteum, otsloyenny from it. It is clinically shown by existence of painless flyuktuiruyushchy opukholevidny formation of an elastic or soft consistence. Typical localization – area of a parietal bone. Diagnostics includes objective inspection of the child, carrying out a neyrosonografiya and X-ray analysis. Tactics of treatment depends on degree of expressiveness of subperiostalny hemorrhage. At kefalogematoma of the I-II degree specific treatment usually is not required, at a kefalogematoma of the III degree punktsionny aspiration is shown.
Kefalogematoma, or subperiostalny hemorrhage – pathology at which peeling of a periost from a skull bone with hemorrhage in the formed space is observed. Is the most frequent patrimonial trauma of newborns in pediatrics and a neonatology. Prevalence makes about 0,2-2,5% of all newborns. Complications are characteristic only at large volumes of hemorrhages. The most private complications are anemia, calcification, jaundice and accession of gnoyerodny microflora. Extremely seldom a cerebral palsy, neurologic violations and lag in psychophysical development develop. Gender tendency to a disease is not revealed. In certain cases the kefalogematoma is a sign of congenital koagulopatiya or generalized mycoplasmosis. An important role is played by differential diagnostics with other patrimonial injuries.
Reasons and classification of a kefalogematoma
Immediate cause of development of a kefalogematoma – damage subperiostalny (is more rare – intra bone) vessels. The mechanism of development consists in the shift of integuments of the head and periosteum in relation to a bone during patrimonial activity. At the same time there is local bleeding, in the created cavity the hematoma is formed. The volume of hemorrhage fluctuates from 5 to 150 ml. Slightly less often the kefalogematoma is formed in the place of cracks of bones of a skull (as a rule – II and III degree). The big body weight (over 4000 g), pathological prelying (pelvic, front, cross), pre-natal anomalies of development (hydrocephaly) and incubation more than 40 weeks (the excessive consolidation of bones interfering change of a configuration of a skull at the time of delivery) are the reasons of development of a disease from a fruit. The list of the reasons from mother includes use of obstetric grants (nippers or vacuum extractors), clinically or anatomic a narrow basin, rapid or long childbirth, irregular and asynchronous sokratitelny activity of a uterus, basin changes in the anamnesis, bone ekzostoza, age of 35 years and are more senior.
In certain cases the kefalogematoma turns out to be consequence of the asphyxia caused obvitiy or squeezing of an umbilical cord, a zapadeniye of language and aspiration of amniotic waters. Besides, hemorrhage in bones of a skull can be the first sign of koagulopatiya (hemophilia, Villebrand's disease). At children with gestation term to 37 weeks this pathology can be display of generalized pre-natal mycoplasmosis.
Depending on diameter of a kefalogematoma allocate 3 degrees of a disease: The I degree – no more than 4 cm, the II degree – from 4 to 8 cm, the III degree – 8 and more see. In the presence of several centers their diameter is summarized and estimated as one hemorrhage. Taking into account the place of emergence distinguish parietal (most characteristic), frontal, occipital (less widespread) and temporal (extremely rare) kefalogematoma. There are isolated and combined forms of a disease. The isolated kefalogematoma is not followed by other pathologies. Speak about the combined kefalogematoma at simultaneous existence of superficial hemorrhage, fractures of bones of a skull and damage of tissues of brain (hypostasis, hemorrhages in brain fabric, neurologic frustration).
Kefalogematoma can be shown both in the first 2-3 hours, and for 2-3 days after the delivery. The general condition of the child depends on existence of other pathologies, the isolated hematomas do not influence a condition of the patient. Quite often hemorrhage increases in the first few days after emergence that is caused by deficiency of factors of fibrillation at newborns. Externally subperiostalny hemorrhage has an appearance of a local tumor with the accurate edges which are not overstepping the bounds of the affected bone. The average size of a hematoma makes 3-7 cm. The multiple kefalogematoma striking several sites of the head are extremely seldom observed.
At survey or the pediatrician define painless formation of an elastic soft consistence with valikoobrazny consolidation on peripheries, a positive symptom of fluctuation and lack of a local pulsation. With a small diameter (to 3 cm) hemorrhage usually independently decreases for 7-9 days and completely disappears 5-8 weeks later. Big kefalogematoma (over 8 cm), it is necessary to punktirovat for aspiration of contents – independently they do not resolve.
The most widespread complications of a kefalogematoma are anemia, suppuration, calcification and jaundice. Anemia is, as a rule, caused by big blood loss, has character hemolytic or post-hemorrhagic and is shown by the characteristic clinical picture including pallor of integuments, increase in ChSS and ChD and other symptoms. Accession of gnoyerodny microflora (β-hemolytic or other streptococci of group A) is followed by classical signs of inflammatory process. The general and local temperature increase of a body, sharp deterioration in a condition of the child and local reddening in the field of a hematoma is noted. Calcification of a kefalogematoma is caused by adjournment of salts of calcium in the formed cavity. It is shown by deformation of the affected bone and the general asymmetry of a skull. Jaundice arises against the background of an extra vascular gemoliz of erythrocytes in a hematoma.
Diagnostics of a kefalogematoma
Diagnostics of a kefalogematoma is based on anamnestichesky and fizikalny yielded, results of laboratory and tool methods of a research. An important role is played by differential diagnostics. From the anamnesis it is possible to establish existence of provocative factors from mother and/or the child. Fizikalny inspection allows to reveal opukholevidny education over one of bones of a skull of the newborn (most often over parietal). At detailed inspection the consistence and clearness of edges of education, existence of a pulsation and fluctuation are estimated.
Laboratory tests at a maloinformativna kefalogematoma are also usually used for an exception of other diseases. Sometimes in the general blood test decrease in quantity of erythrocytes and hemoglobin, in biochemical – increase in the general bilirubin at the expense of indirect fraction is defined. An obligatory method of diagnostics of a kefalogematoma is the neyrosonografiya allowing to find an ekhonegativny zone between periosty and a bone, and also to confirm lack of defeats of tissues of brain. The radiological research gives the chance to exclude or confirm fractures of bones of a skull and to reveal peeling of a periosteum with a clear boundary within one bone. At ambiguity of the received results and suspicion on damage of TsNS fabrics use KT. Differential diagnostics of a kefalogematoma is carried out with podaponevrotichesky hemorrhage, a patrimonial tumor, brain hernia, it is rare – congenital mycoplasmosis and koagulopatiya.
Treatment of a kefalogematoma
Tactics of treatment depends on degree of expressiveness of a kefalogematoma, existence of the accompanying pathologies and a tendency to a rassasyvaniye or progressing. At large hemorrhages and a serious general condition treatment is carried out in the conditions of office of pathology of newborns or neurosurgical office. At a satisfactory general condition and absence of other diseases the child is written out home under observation of the pediatrician or family doctor. Bed rest. The first 3-4 days feeding is carried out by the decanted maternal milk then the patient is transferred to breastfeeding. For prevention of further bleedings and prevention of a hemorrhagic disease of newborns carry out single introduction of vitamin K.
Kefalogematoma III of degree in the absence of positive dynamics is the indication to an aspiration puncture. The procedure is carried out not earlier than the 10th day of life of the child as removal of blood on early terms almost always involves a kefalogematoma recurrence. The approximate duration of treatment in the conditions of a neurosurgical hospital makes from 2 to 7 days. At violation of integrity of integuments in a hemorrhage zone aspiration is carried out to the first two days in connection with high risk of infection. When receiving purulent contents during a puncture opening and drainage of a cavity against the background of antibacterial therapy is shown. Linear cracks of bones of a skull of specific treatment do not demand.
Forecast and prevention of a kefalogematoma
The forecast for children with kefalogematomy, as a rule, favorable. The disease seldom influences the general condition, further life and health of the child. Dispensary observation is not required. Serious complications are observed extremely seldom.
Prevention consists in adequate food and a way of life of mother during incubation of the child, full inspection during pregnancy, regular visit of antenatal clinic, timely detection of risk factors and the correct conducting patrimonial activity. In the presence of indications the rodorazresheniye by Cesarean section is shown.