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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

BACKGROUND Cephalohematoma of infancy is the result of a subperiosteal blood collection that usually forms during birth-related trauma. A small proportion of cephalohematomas can calcify over time, causing a permanent calvarial deformity that is only correctable with surgery. The authors present a technique for the excision and reconstruction of calcified cephalohematoma and their management experience over the past 25 years. METHODS All patients with a diagnosis of calcified cephalohematoma between 1994 and 2019 were identified. Patients were included if the diagnosis was confirmed by a pediatric plastic surgeon or a neurosurgeon. All patients underwent surgical evaluation followed by surgical intervention or observation. Patient demographics and potential risk factors for both surgical and nonsurgical groups were compared using chi-square or Fisher's exact test. Additional data were collected for the surgical cohort. RESULTS Of 160 infants diagnosed with cephalohematoma, 72 met inclusion criteria. Thirty patients underwent surgical treatment. There was no significant difference in demographics, baseline characteristics, or potential risk factors between the operative and nonoperative groups. Mean age at the time of surgery was 8.6 months. Twenty-one surgical patients (70 percent) required inlay bone grafting. All surgery patients had improvement in calvarial shape. The main risk of surgery was blood loss requiring transfusion [eight patients (26.7 percent)]. Thirteen percent of patients experienced minor complications. CONCLUSIONS This series of 72 children with calcified cephalohematomas, 30 of whom required surgical intervention, is one of the largest to date. The technique presented herein demonstrated excellent surgical outcomes by restoring normal cranial contours and was associated with a low complication profile. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

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.

Background: Cephalohematoma is collection of blood between skull and periosteum that is confined by cranial sutures. Cephalohematomas usually resorb spontaneously within the first month of life; however, if it fails to resolve, ossified cephalohematoma may form. Methods: Clinical archiving system and picture archiving and communication system were retrospectively reviewed for cases of birth-related cephalohematoma. Cases of ossified cephalohematomas identified on imaging were retrieved from this subset of patients. Cross-sectional imaging findings in patients with ossified cephalohematomas were evaluated for location, size of the hematoma, and contours of the inner lamella. Results: Out of 115 cases of cephalohematoma, 7 cases had imaging findings consistent with ossified cephalohematoma. All ossified cephalohematomas were located parietally, with size ranging between 18 and 55 mm and the thickness of the outer rim of calcification ranging between 1.5 and 4.8 mm. The contour of inner lamella in relation to the surrounding normal cranial vault was normal in 5 cases, and inner lamella was depressed in 2 cases. Three patients had follow-up imaging available for demonstration of changes in ossified cephalohematoma. The first case was an 11 day-old boy with a cephalohematoma with no signs of calcification at the time of initial imaging. Follow-up at 2 months of age showed partial regression of hematoma cavity with marked calcification at the hematoma walls. The second case was a 3 month-old boy with ossified cephalohematoma at initial imaging. Follow-up imaging at 7 months of age showed almost total regression of hematoma cavity, and approximation of inner and outer lamella with increased thickness of the cranial vault. The third case was a 1 month-old boy with ossified cephalohematoma at initial imaging that totally resolved without residual increased bone thickness at 21-month follow-up. Conclusion: These 3 cases demonstrate the variability in temporal changes that may occur in ossified cephalohematomas.

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.

Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients. We searched the databases of PubMed, Web of Sciences, Scopus and Google Scholar for English articles published since inception until May 2019. A search was also done for Persian articles in Magiran and Scientific Information Database. Studies were evaluated based on predefined criteria by two reviewers. Data analysis was performed by STATA software. A total of 33 articles were finally included. The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows: ABO blood groups incompatibility, 16.9% [95% confidence interval (CI) 10.9–22.8]; Rh blood group incompatibility, 4% (95% CI 2.5–5.5); ABO and Rh blood groups incompatibility, 3.6% (95% CI 0–7.7); glucose-6-phosphate dehydrogenase (G6PD) deficiency, 6.3% (95% CI 5.1–7.5); infection, 6.6% (95% CI 5.2–8.1); hypothyroidism, 4.2% (95% CI 0.1–8.3); infant of diabetic mother: 2.3% (95% CI 0.1–4.5); unknown, 50.7% (95% CI 33.4–68); cephalohematoma, 0.6% (95% CI 0.3–0.9). Regarding treatment of icterus, seven and eight articles were found on phototherapy and exchange transfusion, respectively. In five studies, all patients underwent phototherapy, but rate of exchange transfusion use was between 6.6% and 50.9%. According to the results, unknown factors were the most common causes of icterus in Iranian neonates, followed by ABO blood groups incompatibility, infections and G6PD deficiency. By the way, phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.

Nonsyndromic craniosynostosis results in premature fusion of cranial sutures and is rarely found in the context of other craniofacial abnormalities. Here the authors present the case of a 3-month-old male infant with a rare presentation of sagittal craniosynostosis and concomitant calcified cephalohematoma repaired by endoscopic-assisted sagittal strip craniectomy with good cosmetic and functional outcomes. The authors discuss the advantages of endoscopic repair of craniosynostosis when found in the presence of a cephalohematoma and the need for further research to investigate a possible causal relationship between these 2 pathologies.

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.

В настоящее время не существует единого объяснения возникновения подапоневротических скоплений спинномозговой жидкости у младенцев [1, 2]. В отечественной литературе данную патологию описывают как «эпидурально-поднадкостничные гематомы», либо гемоликворомы [3]. Основная часть авторов среди причин возникновения таких скоплений указывает применение вакуум-экстракции, выполненной по поводу прогрессирующей гипоксии плода. В то же время, имеются единичные сообщения о диагностике таких скоплений после операции кесарева сечения, и даже физиологических родов [4]. Не совпадает мнение исследователей относительно лечебной тактики. Пункция жидкостного подапоневротического образования является элементом диагностики и лечения, но после пункции спинномозговая жидкость нередко скапливается вновь [5]. Приводим клиническое наблюдение спонтанного ликворного скопления у ребенка 2-х месячного возраста. Ребенка после родов наблюдал участковый педиатр с диагнозом «кефалогематома», но в связи с длительным течением заболевания отправлен на консультацию к нейрохирургу. Было заподозрено спонтанное ликворное скопление, проведено пункционное удаление последнего. В ближайшие сутки диагностирован процедив. От повторной пункции родители отказались. Для лечения использовались компрессионные повязки, и через 3 недели констатировано спонтанное рассасывание образования. Редкость данной патологии, необходимость выработки оптимальной тактики лечения объясняют актуальность сообщения., Currently, there is no single explanation for the occurrence of subaponeurotic accumulations of cerebrospinal fluid in infants [1, 2]. In the Russian literature, this pathology is described as «epidural-subcostal hematomas» or hemoliquoromas [3]. The main part of the authors among the causes of such clusters indicates the use of vacuum extraction performed for progressive fetal hypoxia. At the same time, there are isolated reports of the diagnosis of such clusters after cesarean section, and even physiological childbirth [4]. The opinion of researchers regarding therapeutic tactics does not coincide. Puncture of a liquid subaponeurotic formation is an element of diagnosis and treatment, but after puncture, cerebrospinal fluid often accumulates again [5]. We present a clinical observation of spontaneous cerebrospinal fluid accumulation in a child of 2 months. The child was observed after childbirth by a district pediatrician with a diagnosis of «cephalohematoma», but due to the duration of the course of the disease, he was sent for consultation to a neurosurgeon. Spontaneous cerebrospinal fluid accumulation was suspected, puncture removal of the latter was performed. In the next day, a procedure was diagnosed. The parents refused to repeat the puncture. Compression bandages were used for treatment, and spontaneous resorption of the formation was detected after 3 weeks. The rarity of this pathology, the need to develop optimal treatment tactics explains the relevance of the message.

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.

A 13-day-old infant born at 39 weeks’ gestation presents to the outpatient clinic with a previously diagnosed cephalohematoma that was increasing in size. Head ultrasonography showed an unexpected finding (Fig 1). Figure 1. Hypoechoic image in the pericerebral space. ### Prenatal and Birth Histories ### Presentation At 24 hours of age, the infant was found to have a moderate cephalohematoma in the right parieto-occipital region resulting from vacuum extraction. No other abnormalities were found on physical examination. The infant was discharged from the hospital at 48 hours of age. …

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.

A 44-day-old full-term female infant presents to the emergency department (ED) with head swelling (Fig 1). Figure 1. Magnetic resonance imaging of the head shows a right parietal subgaleal collection crossing the midline and measuring approximately 4.7×3.7×0.8 cm and appears hypointense on the T1-weighted sequence (A) and hyperintense on the T2-weighted sequence (B). ### Prenatal and Birth Histories ### Presentation The infant was asymptomatic until 41 days of age when the parents noted swelling over the head while changing her diaper. Parents denied head trauma, change in her activity level, fussiness, vomiting, diarrhea, or other symptoms. Because the patient had no other symptoms, the parents did not seek medical attention until 3 days later when they noticed that the swelling did not resolve. The infant was then evaluated in the ED and admitted at 44 days of age. Cranial ultrasonography was performed (Fig 2). Figure 2. Head ultrasound scan, with the arrow demonstrating …

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.

Cephalohematoma is a subperiosteal collection of blood above the skull. It is associated with operative and prolonged deliveries. In most cases the hematoma spontaneously resolves in a short span of time, usually within one month. In a few cases cephalohematoma can become ossified and require surgical treatment. Traditional belief that ossified cephalohematomas are an exclusively cosmetic issue has been called into question by recent description of EEG anomalies associated to a calcified cephalohematoma. We review relevant surgical literature, and we describe a novel variant of Wong's Radial Cap technique by foregoing healthy bone margin removal, removing the cephalohematoma lamellae in a stepwise fashion and using resorbable plaques for fixation. We furthermore review the rationale, timing and step-by-step execution of the procedure. An exemplary case description is discussed.

Caput succedaneum is defined as a diffuse swelling of the fetal scalp caused by the pressure of the scalp against the dilating cervix during labor. Caput is often associated with molding and may extend across the midline (as opposed to cephalohematoma, which does not cross the suture lines). Prolonged pressure to the fetal scalp causes serosanguinous fluid to leak from the subcutaneous tissue into the area above the periosteum between the scalp and the lining of the periosteum with resultant edema and/or bruising. This location results in a collection of fluid that crosses over the cranial sutures (Fig. 21.1) [1, 2].

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.