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Introduction: According to WHO a neonate, is a child under 28 days of age. The neonatal skin changes show a wide geographic and ethnic variation. It is important to know the pattern of dermatoses prevalent among Indian children during the neonatal period. Aims a nd Objectives: The current study was conducted to study the prevalence of neonatal dermatoses in southern Assam and to study relationship of neonatal dermatoses with maturity and birth weight of neonates. Materials and Methods: 150 neonates who developed cutaneous lesions over a period of one year were examined. Proportion of each dermatoses and prevalence ratio were calculated using relevant formulae. Results: Out of the 150 neonates, 66 % neonates had transient physiological changes, 11.33% had congenital disorders and genodermatoses, 4.67% had iatrogenic complications, 30% had acquired skin diseases, 8% had neonatal infections and 2% had other miscellaneous diseases. The five most common dermatoses overall were diaper dermatitis (17.33%), miliaria (14%), erythema toxicum neonatorum (13.33%), infantile seborrheic dermatitis (12.67%), sebaceous gland hyperplasia (6%) and Mongolian spot (6%). Low birth weight babies had predilection for vernix caseosa, sucking blisters, candidiasis, miniature puberty, caput succedaneum, cephalohematoma, physiological jaundice, infantile acropustulosis, salmon patch, Epstein’s pearls/ Bohn’s nodules, miliaria, sebaceous gland hyperplasia, neonatal acne, Mongolian spot, bullous impetigo, erythroderma Preterm neonates had predilection for vernix caseosa, sucking blisters, miniature puberty, candidiasis, Mongolian spot, caput succedaneum, cephalohematoma, erythroderma, miliaria, Epstein’s pearls/ Bohn’s nodules and a positive association was seen between post-term neonates and physiological desquamation, diaper dermatitis. Neonatal psoriasis and neonatal dermatophyte infection were the unusual findings which we found in our study. Keywords: Erythema T

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods. Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB). Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p 0.05) and III (2.9%, p 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 44.9 ml), when compared to subgroup IA (473 20.7 ml; p 0.05), group II (418 24.9 ml; p 0.05), and group III (347 33.4 ml; p 0.05). There were no differences in blood loss between the outlet OF and VE groups (p 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p 0.01) and in control (5.9%, p 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the childrens hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p 0.05). Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.

Introduction Newborn jaundice is caused by increased levels of bilirubin in the blood of the newborn during the first days after birth. Generally, neonatal jaundice does not need to be treated, however, if the blood bilirubin concentration becomes too high, it can cause neurological damage. Due to the prevalence of neonatal jaundice, it is important to assess its risk factors and their importance. This study at the National University Hospital of Iceland from 1997-2018, determines the risk factors for severe neonatal jaundice and their significance. Material and methods This was a retrospective case control study conducted at the National University Hospital of Iceland. It included all newborns diagnosed with severe jaundice (≥350 micromol/L) following a pregnancy of at least 37 weeks that were treated at the National University Hospital of Iceland from 1997 until 2018. General information on the pregnancy, health of the child at birth, as well as the diagnosis and treatment of jaundice was collected. 339 children met the inclusion criteria for this study. For each child diagnosed with severe jaundice one control was found. Results The incidence of severe jaundice from 1997 to 2018 was 0.52%. Of the 339 children, 16% were found to have a known significant risk factor for severe neonatal jaundice. The most common were ABO incompatibility and cephalohematoma. Only one child had severe neonatal jaundice because of Rhesus incompatibility. Regression analysis revealed the significant risk factors as followins: shorter pregnancy, bruising at birth, male gender, discharge before 36 hours after birth and relative weight loss the first five days of life. 33% were diagnosed during a -routine doctor's examination five days after birth. Conclusion Early discharge from the hospital and -relative weight loss the first few days after birth are significant independent risk factors for severe neonatal jaundice. Most cases were diagnosed during a routine doctors five-day check- up. This indicates that there is room for improvement in the evaluation of jaundice in post-natal home care. Monitoring of neonates with Rhesus incompatibility in Iceland exemplary. Boys are at an increased risk for severe neonatal jaundice. It is espe-cially noteworthy given that the negative effect of jaundice on learning ability appears to be greater in boys than in girls.

Acute soft head syndrome or sickle cell cephalohematoma is not a common sequel or complication of Sickle cell disease (SCD). Here we describe a case report of a 15-year old Saudi male with sickle cell disease who presented with generalized vaso-occlusive crisis. 48 hours post admission, he developed generalized scalp swelling which is consistent with one of the rare complications of sickle cell disease, acute soft head syndrome. The patient was treated conservatively, without aspiration of the scalp swelling. This case draws attention that acute soft head syndrome should be one of the differential diagnoses of scalp pain and swelling in patients with sickle cell disease.

Calvarium subperiosteal hematoma (C-SPOH) is extremely rare in juveniles. We present an extremely rare case of juvenile C-SPOH and a review of the literature. A 12-year-old boy hit his head hard against another player's head during a soccer game. On the next day of the game (Day 02), he noticed a soft bump on the left parietal region. On Day 04, he saw a local physician and was diagnosed with a subgaleal hematoma. The hematoma grew larger, up to twice the size of that on Day 04 and it became more painful over the next five days. A CT scan on Day 10 showed a subcutaneous hematoma that did not cross the suture lines. Aspiration using a syringe with an 18-gauge needle obtained about 45 mL liquefied hematoma and caused the bump collapse with relief of the pain. On Day 12, however, he presented the same bump with similar pains as on Day 10. CT angiography revealed no vascular anomalies or disruptions. A blood sampling test demonstrated normal blood coagulation ability without thrombocytopenia or malnutrition. A second aspiration obtained 45 mL liquefied hematoma. In the second procedure, the hematoma cavity was irrigated with normal saline solution (about 5 mL x 4). He took 250 mg tranexamic acid three times a day and 5 mg prednisolone three times a day for four days. On Day 15, his C-SPOH was not tense and not painful. On Day 22, the periosteal hematoma remained soft and shrunk. A follow-up CT scan showed the complete disappearance of the subperiosteal hematoma on Day 57. The boy has returned to soccer-playing activity without sequelae. This case suggests that 1) C-SPOH can be found in healthy juveniles; 2) Neovascularization along the wall of the C-SPOH cavity may contribute to the formation of the C-SPOH; 3) A simple aspiration of the liquefied SPOH may fail to cure it in juveniles.

Cephalohematoma is a benign medical condition affecting 1 to 2% of all live births, which resolves spontaneously in most of the cases. Infected cephalohematomas are very rare and serious as they can cause sepsis, osteomyelitis and meningitis. We report a case of 40 days male who presented to our outpatient clinic with ruptured scalp swelling. Deep seated scalp abscess was incised and drained. Culture proved E.Coli infection which was managed with intravenous antibiotics for 5 days during the hospital stay and was later discharged on oral antibiotics. The wound completely healed with no evidence of residual abscess on 1-week follow-up. Infected cephalohematoma has good prognosis if appropriately drained and managed on culture guided antibiotics.

Background: Neonatal birth injuries are the third major cause of neonatal mortality in most developing countries. Very few studies have been done in India on birth injuries and its relation to various factors such as undesirable presentations and parity. Aim: The present study was conducted to analyze the birth injuries in our setup to know the various perinatal circumstances leading to birth injuries. Materials and Methods: An observational study was done in which 100 cases of birth trauma were noticed among 850 consecutive viable births during the study period of 2 years. Details of the health status of the mother, antenatal, intra-natal, and postnatal particulars, including the age, sex, weight, mode of delivery, type of presentation, and nature of the birth injury in different modes of delivery and type of presentation of the baby were taken. Results: It was found that of 850 newborn babies, 100 babies were found to have birth injuries, thus giving an incidence of 11.76% per 100 live births. Asphyxia formed the major groups which were noted in 45 babies. Cephalohematoma was the next common injury being noted in 32 cases. A total of 18 babies had soft tissue injuries and 4 babies had neurological injuries. Conclusion: Our findings support to use data on neonatal birth injuries as an indicator to assess the quality and safety of maternity units.

Background Congenital muscular torticollis (CMT) is characterized by persistent head tilt toward the affected side. No consensus exists regarding the cause of this disorder. In this study, we analyzed various clinical factors in patients with CMT who were treated with surgical release. This analysis enabled us to identify potential causative factors of CMT and to establish a basis for surgical interventions. Methods In total, 584 patients who underwent surgical intervention for CMT from October 2007 to December 2016 were included in this study. Their demographic characteristics, birth-related factors, and clinical features were analyzed. Results Data from 525 patients were analyzed in this study after exclusion of those with insufficient information. Before birth, 31 patients (5.9%) were diagnosed with oligohydramnios, and 87 (16.6%) had a breech presentation. Seven (1.3%) cases of clavicle fracture and two (0.4%) cases of cephalohematoma were noted at birth. Before surgery, 397 patients (75.6%) underwent physiotherapy and 128 patients (24.4%) did not. The duration of physiotherapy ranged from 1 to 50 months (average, 6 months). Conclusions Our study shows that 16.6% of the CMT patients presented in the breech position, which is a much higher rate than that observed in the general population (3%–4%). We hypothesize that being in the breech position as a fetus appears to exert a significant influence on shortening and fibrosis of the sternocleidomastoid muscle.

Background Operative vaginal delivery is a procedure that is performed using forceps or vacuum to extract an infant from the birth canal. It has many indications, one of which is prolonged second stage of labor. Although rare, vacuum extraction (VE) can lead to various neonatal and maternal complications. The objective of this study was to compare the rates of different neonatal and maternal complications between vacuum-assisted deliveries and spontaneous vaginal deliveries. Methods This is a retrospective cohort study that was conducted in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The data were collected from the Labor and Delivery Unit at KAMC-J. A total of 745 samples was included (586 delivered spontaneously and 157 delivered by VE). Analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 27.0. Results The median age was 30 years (IQR=36-34). Of all deliveries, vacuum was used in 21.1%. Perineal tear was the most frequent maternal complication (20.9%), while caput succedaneum was the commonest neonatal complication (11.8%). Post-partum hemorrhage was significantly higher among vacuum deliveries (RR=18.8; 95% CI: 5.5-64.15), as well as cephalohematoma (RR=28.9; 95% CI: 8.79-95.04) and caput succedaneum (RR=18.6; 95% CI: 10.99-31.49). The first-minute Apgar score was lower with VE (p < 0.001), and higher perineal tear degrees were reported with VE (p < 0.001). Conclusion The rates of maternal and neonatal complications were significantly higher among vacuum-assisted deliveries. The most serious neonatal complication was subgaleal hematoma, which is considered life-threatening. Further research is recommended to investigate subgaleal hematoma risk factors.

Introduction Cephalohematomas in the newborn period are related to the accumulation of blood between the bone and periosteum as a result of a series of adverse conditions during labor. The optimal approach to cephalohematoma cases is still unclear. In this study, we aimed to present the follow-up data of 94 newborns with a cephalohematoma size of >50 mm and a higher risk of ossification. Methods This is a single-center, non-randomized, prospective, observational study conducted from May 2014 to May 2019. Records of all newborns with cephalohematoma were reviewed in terms of gender, birth weight, cephalohematoma region, transverse/vertical diameter of the lesion, delivery method, and rate of ossification. Results The girl-to-boy ratio was 53/41, with a mean gestational age of 38.3±1.4 weeks and a mean birth weight of 3,300±800 grams. The mean transverse/vertical diameter of cephalohematoma was 59±9 mm. Cephalohematoma was completely resorbed at the first-month control visits in 72 (76.6%) cases, whereas nine (9.57%) had an ossified cephalohematoma. The ossification was completely or partially resorbed in these at the end of the one-year follow-up. Conclusion Hence, we suggest that an early intervention is not required in the routine treatment of cases with hematomas with a size of >50 mm in size unless otherwise stipulated with clinical indications.

Author(s): Acuna, Josie; Adhikari, Srikar | Abstract: Introduction: Cephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma.Case Reports: We describe one case of a 14-month-old male brought to the pediatric emergency department (PED) with concern for head injury. A POCUS examination revealed a large fluid collection that did not cross the sagittal suture. Thus, the hematoma was more consistent with a cephalohematoma and less compatible with a subgaleal hematoma. Given these findings, further emergent imaging was deferred in the PED and the patient was kept for observation. In the second case an 8-week-old male presented with suspected swelling over the right parietal region. A POCUS examination was performed, which demonstrated an extensive, simple fluid collection that extended across the suture line, making it more concerning for a subgaleal hematoma. Given the heightened suspicion for a subgaleal hematoma, the patient was admitted for further imaging and evaluation.Conclusion: Point-of-care ultrasound can be used to help differentiate between a subgaleal hematoma and a cephalohematoma to risk-stratify patients and determine the need for further imaging.

Background: The health system reform plan (HSRP) was launched in Iran on 15 May 2014, with three approaches to protect people from the financial system, create equity in access to health services, and improve the quality of services. Objectives: The present study aimed at investigating the changes in the rate of some rare neonatal outcomes after the implementation of HSRP in Iran. Methods: The present cross-sectional study was conducted in Izadi Hospital in Qom Province, in which 52,817 vaginal delivery and cesarean sections were evaluated for the incidence of complications from 15 June 2011 to 15 April 2017. The complications included hypoxic-ischemic encephalopathy, low Apgar score, cephalohematoma, clavicle fracture, the Erb palsy, and intracerebral hemorrhage. Complications were compared per 10,000 births before and after the implementation of the plan. Data were analyzed with SPSS software using t- and chi-squared tests. Results: There was a significant increase after the implementation of HSRP compared to before that in the rate of complications per 10,000 vaginal deliveries for stage 2 hypoxic-ischemic encephalopathy (P = 0.001), birth with a low Apgar score (P < 0.001), cephalohematoma (P < 0.001), and clavicle fracture (P = 0.002). In the case of cesarean section, there was a significant increase in the 2 (P = 0.001) and 3 (P = 0.034) stages of hypoxic-ischemic encephalopathy and birth with a low Apgar score (P < 0.001). Conclusions: It can be concluded that HSRP could somewhat achieve its goals on the promotion of vaginal delivery. However, the implementation of the plan was associated with an increase in some minor neonatal complications.

Background Factor XIII (FXIII) deficiency is an extremely rare bleeding disorder that is commonly due to mutations in the FXIIIA subunit gene (F13A1), and it has been reported to have a prevalence of one per 2 million. We describe a new genetic variant in the F13A1 gene that caused a patient to suffer from lifelong hemorrhagic diathesis. Case presentation We evaluated a 20-year-old female with umbilical cord bleeding after birth, an intracerebral hemorrhage at age 6, and other bleeding episodes, including hematuria and cephalohematoma, who suffered from a lifelong hemorrhagic diathesis. The clot solubility test showed that the clot of the patient was dissolved in urea solution at 10 h. Genetic testing identified a novel homozygous mutation, c.984C > A(p. Cys328stop), resulting in a premature stop codon in exon 8 of the F13A1 gene. The results obtained with ClusterX software showed that Cys328 of exon 8 in the F13A1 gene is highly conserved among species. Conclusion We reported a novel homozygous mutation in the F13A1 gene in a factor XIII (FXIII)-deficient patient, which adds a new point mutation to the mutant library. In this paper, we discuss other aspects of the disease, including laboratory examination, homogeneous sequence alignment and molecular modeling.

Congenital hypoplasia of depressor angularis oris muscle (CHDAOM) is an uncommon cause of asymmetric crying facies in neonates. Although its etiology is mostly unknown, it has been increasingly recognized as a marker for the presence of other less easily identifiable congenital abnormalities associated with genetic syndromes such as DiGeorge and Cayler syndrome. We report a unique case of a male neonate that highlights the necessity of judicious and accurate clinical documentation with the presence of CHDAOM to avoid unnecessary forms of subsequent work-up.

Purpose Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. Methods We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. Results Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was 9.7±6.9 days. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH

Background. Birth head trauma causing intracranial injury is one of the most common causes of neonatal mortality and morbidity. In case of suspected cranial fractures and intracranial hematomas, diagnostic methods involving radiation, such as x-ray radiography and computed tomography, are recommended. Recently, an increasing number of studies have highlighted the risk of cancer complications associated with computed tomography in infants. Therefore, diagnostic methods that reduce radiation exposure in neonates are important. One such method is ultrasonography (US). Aim. We evaluated US as a non-ionizing radiation method for diagnosis of cranial bone fractures and epidural hematomas in newborns with cephalohematomas or other birth head traumas. Material and methods. The study group included 449 newborns with the most common variant of birth head trauma: cephalohematomas. All newborns underwent transcranial-transfontanelle US for detection of intracranial changes and cranial US for visualization of bone structure in the cephalohematoma region. Children with ultrasonic signs of cranial fractures and epidural hematomas were further examined at a children’s hospital by x-ray radiography and/or computed tomography. Results and discussion. We found that cranial US for diagnosis of cranial fractures and transcranial-transfontanelle US for diagnosis of epidural hematomas in newborns were highly effective. In newborns with parietal cephalohematomas (444 children), 17 (3.8%) had US signs of linear fracture of the parietal bone, and 5 (1.1%) had signs of ipsilateral epidural hematoma. Epidural hematomas were visualized only when US was performed through the temporal bone and not by using the transfontanelle approach. Sixteen cases of linear fractures and all epidural hematomas were confirmed by computed tomography. Conclusion. The use of US diagnostic methods reduced radiation exposure in newborns with birth head trauma. US methods (transcranial-transfontanelle and cranial) can be used in screening for diagnosis and personalized monitoring of changes in birth head trauma as well as to reduce radiation exposure.

Background: Cervical spinal injury encompasses up to 1.5% of all pediatric injuries. Children, and more specifically infants, are a difficult subset of patients to obtain neurological exam in the setting of trauma, thus necessitating the use of cervical X-rays, CT scans, and MRI imaging. Case description: A healthy, 15-month-old boy had an unwitnessed fall down a flight of stairs and received a CT scan of the head and cervical spine in the emergency department due to cephalohematoma and mechanism of injury. The patient was initially diagnosed with a unilateral facet dislocation but after additional imaging and rigorous interdisciplinary discussions, the patient was correctly diagnosed with a congenitally absent left C5 pedicle. Surgical intervention was not pursued and the patient was discharged home with close follow up. Conclusion: In the acute trauma setting, congenital absent cervical pedicle can be difficult to differentiate from unilateral facet dislocation and may require the use of advanced imaging and close communication between the neurosurgery and radiology departments. Given the high morbidity and mortality involved in the repair of facet dislocation in a child, it is crucial to maintain high degree of clinical suspicion for absent spinal pedicle. In this case, the patient nearly underwent surgical intervention, but was ultimately able to be discharged home with no symptoms or deficits after correct diagnosis. Keywords: Cervical spine injury, Deformity, Congenital, Absence, Pedicle, Trauma, Pediatrics

One of the most common types of birth injuries is locomotor trauma: cephalohematomas of the parietal and occipital regions, injuries of the clavicles and tubular bones. The main clinical manifestations of birth trauma are subperiosteal hemorrhages, fractures, local swelling, limited movements; common symptoms (a negative response and a baby’s crying, changes in heart rate, cardiac auscultatory pattern, blood pressure, pale skin, etc.). The purpose of this study is to improve the quality of medical care for the newborns, by monitoring the clinical manifestations of birth trauma. Sixty-seven newborn infants with skeletal birth trauma were examined. Significant changes were found in the function of the cardiovascular system (reduced systolic and diastolic blood pressure, increased pulse pressure, tachycardia, more rarely bradycardia, pale skin, and muffled heart sounds); indicators of pain syndrome (moderate and severe pain according to the Neonatal Infant Pain Scale (NIPS) in one-third of the patients); electrocardiographic changes (shortening of the QT and RR intervals, extension of the QRS complex, increased systolic index); neurosonographic changes (periventricular edema and hypoxic changes in all newborns with birth trauma). The findings are objective criteria for the severity of neonatal conditions and will assist in optimizing combination therapy for little patients with skeletal birth trauma.

Introduction or background Hemorrhage in neonates is an alarming sign that requires prompt recognition and management. Causes can be as simple and contained as cephalohematoma to life-threatening bleeding. One of the rare causes is having an underlying factor VII deficiency. It is a rare autosomal recessive disorder that involves disruption of the cascade of the extrinsic coagulation pathway leading to early onset bleeding. Objectives To describe a case of factor VII deficiency and provide a literature review. Clinical Case A 3 days old term female neonate, who had an uneventful perinatal course, discharged home and then presented to our facility with significant hematemesis as well as deranged coagulation profile. PT was 78 (ref. 13.5 - 16.4) and INR of 7.44 (ref. 1.05 – 1.35). PT normalized to 13.2 after the ‘mixing study’. Factor VII level was 1.4 (ref. 35–143) very low. She was diagnosed as having factor VII deficiency and given FFP and recombinant factor VII. She was discharged home with subsequent follow ups. Her diagnosis was confirmed by genetic testing. Conclusion(s) Review of the Literature reveals that there are few reports on factor VII deficiency. This condition is rare and physicians need to have more awareness of it as it is crucial to establish prompt diagnosis and treatment to prevent major complications.

Objective: to provide the comparative characteristics of neurological impairments in infants born in the I and II obstetric positions and to follow them up in the neonatal period. Subjects and methods. A total of 133 infants born by vaginal delivery at 38–41 weeks» gestation in 2014 to 2016 were followed up. All the examinees were divided into 2 groups: 1) 71 neonates born in the I obstetric position; 2) 62 babies born in the II position. Their clinical examination encompassed an analysis of the course of delivery, neurological examination of the newborn in the first hours of life with a subsequent follow-up evaluation at the time of his/her discharge from the maternity unit. Results and discussion . The examined groups were comparatively analyzed in terms of a number of indicators. The data of objective neurological examination showed a significant difference in some symptoms: cephalohematoma and torticollis were more common in the group of infants born in the II position. Comparison of the frequency of neurological impairments at different follow-up stages (at birth and at discharge from the maternity unit) revealed their statistically significant reduction in both groups. However, the frequency of neurological symptoms among Group 1 infants (born in the I position) at their discharge from the maternity unit was significantly reduced (from 77.5 to 38.0 %; p < 0.001), and those in Group 2 infants (born in the II position) substantially unchanged (from 87.1 to 79.0 %; p = 0.125). The slight regression of neurological symptoms in Group 2 suggests that intranatal nervous system damage is more severe in the infants born in the II position. Conclusion . To define the position of a fetus during labor is an important component in the prevention of intranatal injuries

Purpose: To explore whether the characteristics of vacuum delivery are associated with the occurrence of head injury and neonatal complications. Methods: Retrospectively cohort study of vacuum-assisted attempted vaginal deliveries of singletons. We studied the association of total duration of vacuum application and number of pulls and cup dislodgement with (1) primary outcome: the occurrence of major (subgaleal hemorrhage, skull fracture, and intracranial hemorrhage) or minor (cephalohematoma, scalp laceration more extensive than simple abrasions) neonatal head injuries and (2) secondary outcome: the occurrence of neonatal complications, including 5-min Apgar score

A 29-day-old infant presented to the emergency department (ED) with increasing painless scalp swelling. The swelling was first noted 2 weeks ago. Since that time, it has doubled in size. The family denied a history of trauma. She was born at term by cesarean delivery for failure to descend with fetal distress. Neither vacuum nor forceps were used. A fetal scalp electrode was placed during labor. After delivery, intramuscular vitamin K was administered. Her newborn course was complicated by hypoglycemia attributed to poor feeding. Scalp swelling was not present at birth or during the newborn hospitalization. There were no issues with jaundice and her newborn metabolic screen was normal. Since discharge, she has been exclusively fed breast milk and has been growing well, with documented weight gain of 30 g per day. The scalp swelling was first noticed by the family at 2 weeks of age. She was evaluated by her physician at 19 days of age and was otherwise well and asymptomatic. Our review of her symptoms was negative for fever or vomiting. An ultrasound revealed a 2.3 cm by 0.5 cm superficial fluid collection medially adjacent to the skull. It did not appear to communicate intracranially. On the basis of the images, it was believed to be a small focus of caput succedaneum or a small cephalohematoma. Per the radiologist, additional imaging may be warranted if the swelling did not resolve or demonstrate notable improvement over the next 4 to 6 weeks. The family was instructed to monitor the swelling at home. The day of presentation, the swelling had doubled in size, prompting the parents to seek evaluation in the ED. In the ED, her vitals were all within normal limits and she was well appearing. The physical examination was notable for a 4 cm by 6 cm …

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.

We report a case of Escherichia coli infection of a cephalohematoma in an infant delivered by vacuum extraction. After excluding potential complications, the patient was treated with intravenous ceftriaxone while hospitalized followed by oral cephalexin after discharge. Infection is a rare but serious complication of cephalohematomas in the newborn period. Escherichia coli is the most common pathogen responsible for infected cephalohematomas. Clinicians should be aware that infected cephalohematomas may be complicated by sepsis, meningitis, or osteomyelitis.

The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large cohort of children with moderate and severe VWD. We included 113 children (aged 0-16 years) with Type 1 (n = 60), 2 (n = 44), and 3 (n = 9) VWD with von Willebrand factor (VWF) antigen and/or VWF ristocetin cofactor levels ≤ 30 U/dL from a nation-wide cross-sectional study ("Willebrand in the Netherlands" study). Bleeding severity and frequency were determined using the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) with supplementary pediatric-specific bleeding symptoms (umbilical stump bleeding, cephalohematoma, cheek hematoma, conjunctival bleeding, postcircumcision and postvenipuncture bleeding). We found that all 26 postmenarche girls experienced menorrhagia. Other common bleedings were cutaneous (81%), oropharyngeal (64%), prolonged bleeding from minor wounds (58%), and epistaxis (56%). Pediatric-specific bleeding symptoms were present in 44% of patients. ISTH-BAT bleeding score was higher in index cases than in affected family members (median, 12.0 vs. 6.5, P

Objective – This case report presents a child born at 41 weeks gestational age with a cephalohematoma that spontaneously evolved into abscess. Case report – We report the case of a newborn Chinese boy, born at 41 weeks by a spontaneous delivery, presented on the 18th day of life with a soft-tissue parietal-temporomandibular mass that spontaneously evolved into abscess. Surgical incision and cleaning of the abscess cavity were performed and systemic antibiotic therapy was carried out with resolution of the infection. The fluid and blood cultures grew Escherichia coli. Conclusions – Infected cephalohematoma requires all microbiological and biochemical laboratory exams to rule out a systemic associated infection. Double antibiotic therapy should be started immediately.

Infected cephalohematoma associated with meningitis is rare in neonatal period. Herein we report a neonate with huge infected cephalohematoma associated with meningitis, which was caused by Escherichia coli. With intravenous antibiotic therapy and surgical drainage of the infected cephalohematoma, he became afebrile soon. Intravenous ceftriaxone therapy was continued for 21 days and no sequela was reported. It is suggested that meningitis should be considered in neonates with infected cephalohematoma.

Birth injuries are a diverse set of traumas afflicting a newborn during labor and/or delivery. These range from temporary paralysis to hematomas. Herein, a comprehensive review of the birth injuries is presented, including the risk factors, classification of various paralyzes and nerve damage, as well as bleeding complications. The predicted outcomes and complications, as well as the treatment options for various birth injuries, are also discussed.

Cephalohematoma, one of the most common neonatal head injuries, generally undergoes spontaneous resorption. When calcified, it may cause cranial vault distortion and depression of the inner skull layer, although it remains asymptomatic. Surgery, indeed, is usually performed for cosmetic purposes. For these reasons, the long-term effects of calcified cephalohematoma (CC) are widely unknown. The authors report the case of an 11-year-old girl with a persistent calcified CC causing skull deformity and delayed electroencephalography (EEG) anomalies. These anomalies were detected during routine control EEG and were not clinically evident. The young girl underwent surgical removal of the CC for cosmetic purpose. The EEG abnormalities disappeared after surgery, thus reinforcing the hypothesis of a correlation with the brain “compression” resulting from the CC. To the best of the authors' knowledge this is the first time that CC-associated EEG anomalies have been described: even though these anomalies cannot be considered an indication for surgery, they merit late follow-up in case of skull deformity.