List of Abbreviations
CH – cephalhematoma
CT – computed tomography
NSG – neurosonography
MRI – magnetic resonance imaging
Terms and Definitions
Cephalhematoma (CH) is a defined firm, tense area of hemorrhage overlying the cranial bones, limited by its sutures, and is subperiosteal [1, 2].
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Birth trauma is organ damage resulting from mechanical causes during childbirth [1].
Cephalhematoma (CH) is a defined firm, tense area of hemorrhage overlying the cranial bones, limited by its sutures, and is subperiosteal [1, 2].
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
Risk factors for CH formation can be divided into three main groups: maternal, birth-related, and fetal [3, 4].
Maternal factors include the mother's age (under 16 and over 35 years), pelvic abnormalities, and chronic maternal diseases [4–9]. CH is more frequently observed in first-time pregnancies and primiparous women, as well as in women with genital infantilism [3, 4, 8, 9]. Poorly controlled diabetes mellitus in the mother is a major cause of fetal macrosomia and the potential development of CH [4, 9]. Administration of anticoagulants and antiplatelet agents to pregnant women affects the fetal blood coagulation mechanism and may thereby contribute to cephalhematoma formation [4, 9, 10].
Birth-related risk factors include the condition of the maternal birth canal, method of delivery, prolonged and precipitous labor, oligohydramnios, and the use of obstetrical forceps [2, 3-6, 10, 13, 14]. CH is more commonly recorded in infants born via vaginal delivery [3, 10, 14]. The incidence of CH is associated with the qualifications and skills of the medical personnel providing intrapartum care [2, 3, 6, 8, 12, 13].
Instrumental deliveries increase the likelihood of CH development: forceps usage accounts for 4.3% to 9.5%, and vacuum extraction accounts for up to 10% [1, 2, 15–17].
The use of vacuum extraction and obstetrical forceps increases the risk of CH development by 3–4 times [3, 18, 24, 26].
Fetal risk factors include prematurity, post-term pregnancy, breech presentation, developmental anomalies, large head size, and macrosomia [1–3, 5, 6, 8, 12–14]. CH is more frequently recorded in boys compared to girls [4, 9, 11]. A birth weight of 4.0–4.5 kg is associated with a twofold increase in the risk of birth trauma. This risk increases 3-fold if the birth weight is 4.5–5.0 kg, and more than 4.5-fold if the newborn weighs over 5 kg [3, 8].
Cephalhematoma (CH) can be one of the clinical manifestations of hemorrhagic disease of the newborn, thrombocytopathy, hemophilia A, B, and C, hypofibrinogenemia, afibrinogenemia, and dysfibrinogenemia, as well as other hereditary coagulopathies [2, 4–7, 9, 19, 20].
In 30–32% of cases, CH may develop independently of predisposing factors [5, 7, 9, 12, 13, 14, 21, 26].
CH occurs due to mechanical impact and in the overwhelming majority of cases is the result of traumatic injury.
The main causes of CH are obstetric factors associated with the disproportion between head size and the birth canal, as well as instrumental intervention, which leads to disruption of the tight adherence of subcutaneous structures to the periosteum and the separation of the periosteum from the bone under the influence of external forces.
Instrumental delivery increases the likelihood of CH: the use of forceps ranges from 4.3% to 9.5%, and vacuum extraction up to 10%. The use of vacuum extraction triples the likelihood of CH formation [1, 2].
CH is a subperiosteal hemorrhage. The subperiosteal location explains why the hematoma is contained by the cranial sutures [1]. During severe compression of the cranial bones as the head passes through the birth canal, the periosteum shifts and detaches. This leads to damage and/or rupture of blood vessels, resulting in the accumulation of blood in the subperiosteal space [5–7, 22, 26]. Periosteal detachment can occur with marked head molding, as well as with the use of obstetric forceps and vacuum extraction [3, 6, 9, 14]. Since bleeding occurs in a confined subperiosteal space, as the volume of the CH increases, blood vessels are compressed, which contributes to the spontaneous cessation of bleeding [4–6].
In 10% of cases, an underlying bone fracture occurs, most commonly linear. In 30% of newborns, CH is combined with intracranial hemorrhage [1, 8, 23].
The most frequent localization site for CH is unilateral over the parietal bone. Occipital CH is rare and, due to containment by the lambdoid sutures, can mimic an occipital encephalocele [1].
1.3 Epidemiology of the Disease or Condition
CH occurs in approximately 0.2% to 4.0% of live births with no trend toward a change in detectability [10, 13, 14, 25–27]. Among premature infants, the incidence is 20% [1].
1.4 Features of Coding the Disease or Condition
P12.0 Cephalhematoma due to birth injury.
1.5 Classification of the disease or condition
CH is classified as an extracranial lesion along with caput succedaneum and subaponeurotic hemorrhage [1].
CH can be focal (a subperiosteal elevation of various sizes) or diffuse (involving an entire cranial bone) [28].
According to the maximum diameter of the hemorrhage, CH is categorized by size into small or grade 1 (up to 4 cm), medium or grade 2 (4.1 to 8 cm), and large or grade 3 (greater than 8.1 cm) [5, 6, 9, 20, 24].
Depending on localization, unilateral and bilateral CH are distinguished [5, 6, 9, 20, 24].
1.6 Clinical presentation of the disease or condition
CH typically forms within the first three days of the newborn's life; immediately after birth, it is difficult to differentiate from a caput succedaneum [5, 6, 7, 19, 26].
CH can be localized on any bone of the cranial vault [5, 6, 7, 11, 19].
Up to 88% of CH cases are located in the parietal bone region, up to 12% in the occipital bones, and occasionally in the temporal bones [7, 11, 24, 13]. 89% of hematomas are unilateral and 11% are bilateral (typically in the parietal bone region) [9].
The hemorrhage is typically round or oval in shape, with clearly defined boundaries, dense, resilient, tense consistency, non-pulsatile, painless, and does not extend across cranial sutures to the adjacent bone. The skin over the CH is usually unchanged, though petechiae are occasionally possible [5, 6, 7, 11, 13, 18, 22, 26]. The hematoma increases in size over three days [3, 5, 6, 8, 11, 19].
In terms of volume, grade 2 CH is most common (up to 65%), while grade 1 CH (up to 25%) and grade 3 CH (up to 10%) are recorded less frequently [5, 6, 9, 20, 24].
Resorption of CH begins by the 10th–14th day of life. With the onset of resorption, its center becomes somewhat depressed, and a dense ridge begins to form along the edges of the hemorrhage [5, 6, 8, 11, 19, 24].
Complete resorption of most hemorrhages occurs by the 6th–8th week of the child's life. In 2–5% of cases, CH resorption does not occur, and complications in the form of infection and ossification (calcification) may arise [5, 6, 24, 26].
In large hemorrhages, hypotension, anemia, and jaundice develop in some cases [5, 6, 7]. Neurological symptoms usually occur when CH is combined with intracranial hemorrhage [1]. Hyperbilirubinemia is detected in 11% of cases [9].
Risk factors for CH infection include a prolonged anhydrous period, instrumental delivery maneuvers, abrasions and skin damage on the head, bacteremia, and the use of intrauterine monitoring electrodes [29, 30].
Primary infection occurs as a result of skin damage in the head region; secondary infection occurs due to bacteremia, sepsis, or meningitis [29]. The main pathogenic agents responsible for CH infection are Escherichia coli, Staphylococcus aureus, Klebsiella, and Proteus [3, 29–31].
Local changes in this complication include skin alterations, erythema, fluctuation, tenderness, and purulent discharge [5, 6, 29–31].
Systemic signs include restlessness, irritability, possible lethargy, thermoregulation disorders, feeding difficulties, and worsening jaundice and pallor [29, 30]. Leukocytosis and elevated C-reactive protein levels may be present [30]. CH infection can lead to sepsis, meningitis, osteomyelitis, and death [3, 29–31]. When CH becomes suppurative, meningitis develops in 26% of children and sepsis in 42% [29]. Mortality rates for sepsis are 35.7% [31].
The main treatment method for an infected subperiosteal hemorrhage is aspiration and drainage, as well as antibacterial therapy taking into account pathogen sensitivity [29–31].
Ossification (bone formation, calcification) of CH occurs in 2–5% of cases [13, 20, 22, 26].
Ossification deforms the cranial vault, altering its shape and causing asymmetry [5, 11, 14, 21, 22, 26]. There are 2 types of calcification: type 1 consists of preserving the shape of the inner table of the bone without depression into the cranial cavity and is more common in small hematomas; type 2 involves depression of the inner table into the cranial cavity and usually develops with large hemorrhages [1, 22, 26]. Type 1 ossification requires subperiosteal removal; type 2 requires cranioplasty [22, 26].
2. Diagnostics, medical indications and contraindications for diagnostic methods
Criteria for establishing the diagnosis of cephalhematoma:
The diagnosis is established based on a visual examination of the cranial bones. Palpation of the cranial bones reveals an elevation of dense, resilient, or tense consistency, limited to the area of a single bone. Unlike a caput succedaneum, a cephalhematoma persists after 24 hours of life.
2.1 Complaints and Anamnesis
It is recommended to study the maternal medical history, the course of pregnancy and labor, and the dynamics of the newborn's condition in order to identify maternal, obstetric, and fetal risk factors for CH development [1, 2, 5–7, 19].
GR CLEL 5Grade of Recommendation C (Level of Evidence – 5).
It is recommended to describe the infant's condition dynamics based on the accounts of the mother and medical staff from the time of birth, or in cases of delayed onset, the timing and nature of clinical deterioration to determine the course of the disease [1, 2, 5–7, 19].
GR CLEL 5Grade of Recommendation C (Level of Evidence – 5).
Comments: see section 1.2.
2.2 Physical Examination
It is recommended to perform a visual physical examination of the newborn to identify CH and determine further management tactics (see section 1.6) [1, 2, 5–7, 19].
GR CLEL 5Grade of Recommendation C (Level of Evidence – 5).
Comments: the visual physical examination of a newborn with CH includes:
– assessment of the level of consciousness (normal, stupor, coma);
– reaction to examination (normal, agitation, depression);
– examination of the skull (presence of extracranial hematomas, skin integrity damage, bruising, state of sutures and fontanelles);
– evaluation of the central nervous system status: spontaneous activity, active (posture) and passive muscle tone, deep reflexes, neonatal reflexes, neck-tonic and labyrinthine reflexes, autonomic status, cranial innervation, presence or absence of tremor and seizures;
– examination of the skin and visible mucous membranes with assessment of the degree of pallor, presence and degree of jaundice, hydration status, detection of skin rashes, hemorrhagic manifestations, microcirculatory disorders;
– percussion and auscultation of the lungs and heart, pulse examination;
– abdominal palpation;
– examination of the external genitalia;
– identification of visible birth defects and dysmorphic stigmata.
To assess CH dynamics in a newborn, it is recommended to measure the dimensions of the hemorrhage along with an assessment of its consistency, mobility, and tenderness [1, 2].
GR CLEL 5Grade of Recommendation C (Level of Evidence – 5).
2.3 Laboratory Diagnostics
Newborns with cephalhematoma in uncomplicated cases do not require laboratory diagnostic tests [1, 2, 5–7, 11, 13, 19].
2.4 Instrumental Diagnostics
It is recommended that a newborn with cephalhematoma undergoes neurosonography (NSG) and/or plain radiography of the entire skull in one or more projections to rule out skull fractures [32, 40-42].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comment: the scope of the study depends on the equipment available at the medical institution.
It is recommended that a newborn with cephalhematoma undergoes (depending on the equipment available at the medical institution) neurosonography, computed tomography (CT), or magnetic resonance imaging (MRI) of the brain to rule out intracranial hemorrhage [33].
Level of Recommendations CLevel of Evidence 5Level of recommendations C (level of evidence – 5).
Comment: the scope of the study depends on the equipment available at the medical institution.
2.5 Other Procedures
It is recommended that a newborn with cephalhematoma undergoes an initial/follow-up appointment (examination, consultation) with a neurologist if intracranial hemorrhage is suspected and/or confirmed, as well as in case of changes in neurological status [1, 2].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
It is recommended that a newborn with cephalhematoma and suspected and/or confirmed intracranial hemorrhage undergoes an initial/follow-up appointment (examination, consultation) with a neurosurgeon to determine further treatment tactics [41, 43].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
It is recommended that a newborn with cephalhematoma and suspected and/or confirmed suppuration undergoes an initial/follow-up appointment (examination, consultation) with a pediatric surgeon to determine further treatment tactics [1, 2].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comments: see section 1.6.
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Conservative Treatment
It is recommended that a newborn with cephalhematoma undergoes an initial/follow-up appointment (examination, consultation) with a pediatrician. Most cephalhematomas are characterized by spontaneous resorption and complete resolution within several weeks or months [1, 2, 11, 13] [5–7, 19].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
3.2 Surgical Treatment
Cephalhematoma puncture is not recommended for newborns due to the high risk of severe infectious complications [2, 5–7, 11, 24].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Aspirating hematomas is not recommended for newborns, as it may contribute to recurrent bleeding [2, 5–7, 11, 24].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Surgical intervention is recommended for a newborn with cephalhematoma only in cases of suppuration for the purpose of its removal [24].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comments: surgical intervention includes incision of the soft tissue hematoma.
3.3 Other Treatment
Not applicable.
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
Prevention of cephalhematoma formation in a newborn consists of reducing the occurrence and impact of risk factors and belongs to the category of primary prevention.
Appropriate management of pregnancy is recommended in young women and women with infantilism, diabetes mellitus, along with cautious prescription of antithrombotic agents (ATX code B01A) [1, 2, 4, 8, 9].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Monitoring the condition of the parturient's birth canal, oligohydramnios, the rate and mechanics of labor, and the use of instrumental delivery with an increase in the professional qualifications of the personnel conducting the delivery are recommended [1, 2, 4, 8, 9].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Prevention of prematurity and post-term pregnancy, correct management of pregnancy and delivery with the fetus in breech and pelvic presentations, and timely diagnosis and correction of coagulopathies in the fetus and newborn are recommended [1, 2, 4, 8, 9].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
6. Organization of Medical Care
Surgical treatment of cephalhematoma is performed in an inpatient setting. If it is impossible to consult a pediatric surgeon and/or there is a need to provide medical care in the specialty of "pediatric surgery", the child is indicated for transfer to an appropriate medical organization.
In the presence of concomitant intracranial hemorrhage, if it is impossible to consult a neurosurgeon and/or there is a need to provide medical care in the specialty of "neurosurgery", the child is indicated for transfer to an appropriate medical organization.
Indications for patient discharge from a medical organization:
No increase in the size of the cephalhematoma;
Satisfactory condition of the patient;
Absence of other contraindications to discharge.
7. Additional Information
The outcome of neonatal cephalhematoma is determined by the cause and mechanism of hemorrhage development, its volume, the presence or absence of skull damage and concomitant intracranial hemorrhage, the formation of ossification and infection of the hematoma, concomitant anemia, hyperbilirubinemia, and hemostatic disorders (see section 1.6).
In the vast majority of cases, the prognosis is favorable without medical intervention, and intervention is necessary only in cases of the aforementioned complications [1, 2].
Formulation and coding of the clinical diagnosis:
Birth trauma of the scalp: cephalhematoma (indicate localization: e.g., left parietal bone). ICD-10 code: P12.0
Criteria for Evaluating the Quality of Medical Care
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Appendix A1. Working Group Composition
Dmitry O. Ivanov – MD, PhD, Professor, Rector of St. Petersburg State Pediatric Medical University of the Russian Ministry of Health, Chief freelance neonatologist of the Russian Ministry of Health.
Aleksey V. Minin – PhD in Medical Sciences, Associate Professor of the Department of Neonatology with Courses of Neurology and Obstetrics and Gynecology of the Faculty of Postgraduate and Additional Professional Education, St. Petersburg State Pediatric Medical University of the Russian Ministry of Health.
Aleksandr B. Palchik – MD, PhD, Professor of the Department of Neonatology with Courses of Neurology and Obstetrics and Gynecology of the Faculty of Postgraduate and Additional Professional Education, St. Petersburg State Pediatric Medical University of the Russian Ministry of Health.
Andrey E. Ponyatishin – PhD in Medical Sciences, Associate Professor of the Department of Neonatology with Courses of Neurology and Obstetrics and Gynecology of the Faculty of Postgraduate and Additional Professional Education, St. Petersburg State Pediatric Medical University of the Russian Ministry of Health.
Mariya Yu. Fomina – MD, PhD, Professor of the Department of Neonatology with Courses of Neurology and Obstetrics and Gynecology of the Faculty of Postgraduate and Additional Professional Education, St. Petersburg State Pediatric Medical University of the Russian Ministry of Health.
Ekaterina N. Balashova – PhD in Medical Sciences, Leading Researcher of the Professor A.G. Antonov Resuscitation and Intensive Care Department, Institute of Neonatology and Pediatrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, Associate Professor of the Department of Neonatology, Institute of Professional Education, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, Associate Professor of the Department of Neonatology, I.M. Sechenov First Moscow State Medical University of the Russian Ministry of Health (Sechenov University), Member of the Council of the Russian Society of Neonatologists, Moscow.
There is no conflict of interest.
Appendix A2. Methodology for Developing Clinical Guidelines
Methods used for evidence collection/selection: electronic database search.
Description of methods used for evidence collection/selection: the evidence base for the guidelines included publications from the Cochrane Library, PubMed, EMBASE and MEDLINE, Scopus, Web of Science, eLIBRARY, clinicaltrials.gov, electronic libraries, and clinical guidelines published by the National Institute for Health and Care Excellence (NICE), the European Association of Perinatal Medicine (EAPM), the European Society for Pediatric Research (ESPR), the European Foundation for the Care of Newborn Infants (EFCNI), and the European Society for Neonatology (ESN). The search depth was 56 years.
Methods used to assess the quality and strength of evidence:
– expert consensus;
– significance assessment according to a rating scheme.
Scales for assessing levels of evidence certainty (LEC) (Tables 1 and 2) for diagnostic, preventive, therapeutic, and rehabilitation methods (interventions) with definitions, and the scale for assessing levels of recommendation consensus (LRC) (Table 3) for preventive, diagnostic, therapeutic, and rehabilitation methods (interventions).
Methods used for evidence analysis:
– reviews of published meta-analyses;
– systematic reviews with evidence tables.
Description of methods used for evidence analysis.
When selecting publications as potential sources of evidence, the methodology used in each study was reviewed to ensure its validity. Methodological evaluation was based on questions focused on study design features that significantly affect the validity of the results and conclusions.
To minimize potential subjective errors, each study was evaluated independently by at least two members of the working group. Any discrepancies in assessments were discussed by the full working group. If consensus could not be reached, an independent expert was involved.
Economic analysis:
Cost analysis was not performed, and pharmacoeconomic publications were not reviewed.
Method of recommendation validation:
– external peer review;
– internal peer review.
Description of the guideline validation method:
The preliminary version of these guidelines was reviewed by independent experts who were asked to comment primarily on whether the interpretation of the evidence underlying the recommendations was accessible and understandable.
Comments were received from primary care physicians and district pediatricians regarding the clarity of the presentation of the guidelines and their assessment of the importance of the guidelines as a working tool in daily practice.
The draft version was also sent to a non-medically trained reviewer to obtain comments from a patient perspective.
Comments received from experts were carefully systematized and discussed by the chair and members of the working group. Each point was discussed, and resulting modifications to the guidelines were recorded. If no changes were made, the reasons for declining the changes were recorded.
Consultation and peer review:
Recent changes to these guidelines were presented for discussion as a draft version. The updated version for broad discussion was posted on the website of the Russian Society of Neonatologists (RSN) www.neonatology.pro and https://portalcr.minzdrav.gov.ru to ensure that all interested parties could participate in discussing and improving the guidelines.
The draft guidelines were reviewed by independent experts who were asked to comment primarily on the clarity and accuracy of the interpretation of the evidence base underlying the recommendations.
For the final revision and quality control, the recommendations were re-evaluated by the members of the working group, who concluded that all comments and feedback from the experts had been taken into account and the risk of bias in the development of the recommendations was minimized.
Target audience for these clinical guidelines:
neonatologists;
neurologists;
pediatricians;
neurosurgeons;
pediatric surgeons;
medical school students;
residents and interns.
Table 1. Scale for assessing levels of evidence (LE) for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference standard control or systematic reviews of randomized controlled trials with meta-analysis |
2 | Individual studies with reference standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Scale for assessing the levels of evidence (LE) for prevention, treatment, and medical rehabilitation methods, including those based on natural therapeutic factors (preventive, therapeutic, and rehabilitation interventions)
LoE | Definition |
|---|---|
1 | Systematic review of RCTs with meta-analysis |
2 | Individual RCTs and systematic reviews of studies of any design except RCTs, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Scale for assessing the grades of recommendation (GR) for prevention, diagnostic, treatment, and medical rehabilitation methods, including those based on natural therapeutic factors (preventive, diagnostic, therapeutic, and rehabilitation interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines.
The mechanism for updating clinical guidelines provides for their systematic revision at least once every three years, as well as upon the emergence of new evidence-based medicine data on the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or in the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
Appendix A3.1 Related Documents
Federal Law No. 323-FZ of November 21, 2011, "On the Fundamentals of Health Protection of Citizens in the Russian Federation."
Order of the Russian Ministry of Health No. 203n of May 10, 2017, "On Approval of Criteria for Assessing the Quality of Medical Care."
International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) (World Health Organization), 2019 version.
Order of the Russian Ministry of Health No. 804n dated October 13, 2017 (as amended on September 24, 2020, with amendments dated October 26, 2022) "On Approval of the Nomenclature of Medical Services" (Registered with the Ministry of Justice of Russia on November 7, 2017, No. 48808).
Methodological Letter "Resuscitation and Stabilization of Newborn Infants in the Delivery Room" No. 15-4/i/2-2570 dated March 4, 2020. Edited by E.N. Baybarina. Moscow: Ministry of Health of the Russian Federation; 2020.
Order of the Russian Ministry of Health No. 222n dated April 17, 2025, "On Approval of the Procedure for Providing Medical Care in the Profile 'Neonatology'" (Registered with the Ministry of Justice of Russia on June 2, 2025, No. 82516).
Order of the Russian Ministry of Health No. 514n dated August 10, 2017 (as amended on November 19, 2020) "On the Procedure for Conducting Preventive Medical Examinations of Minors."
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
Cephalhematoma in a newborn is a condition characterized by hemorrhage between the periosteum and the cranial bone (soft tissue covering the bone) of the scalp.
Factors contributing to the development of cephalhematoma may include various conditions and diseases of the pregnant woman (primiparity, overweight, diabetes mellitus, blood coagulation disorders), characteristics of labor, and conditions and diseases of the fetus and newborn (occipital or breech presentation, prematurity and post-term pregnancy, blood coagulation disorders). In one-third of cases, cephalhematoma occurs without identifiable causes.
In the absence of complications, a newborn's cephalhematoma does not cause impairments in the infant's condition, requires no medical intervention, has a favorable course, and leaves no consequences for the child's health and development.
In rare cases of a complicated course (infection, ossification), combination with a skull fracture or intracranial hemorrhage, bleeding, anemia, or jaundice, observation and treatment by a neonatologist and specialist physicians are required depending on the nature of the complication, along with the prescription of appropriate additional diagnostic tests.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
Not applicable.