trauma in the neonatal period usually occurs during delivery. Physical
abuse by a caretaker is infrequent in neonates. The possibility of spinal
injury should be considered in every neonate with head trauma.
hypotonia that results from head injury is initially associated with
decreased dynamic tone, but after a few weeks dynamic tone increases.
Clinical features that suggest head trauma are scalp bruises and equimosis,
caput succedaneum (Figure 106.1 [A]), subgaleal hemorrhage (Figure 106.1
[B]), cephalohematoma, and linear and depressed skull fractures. Caput
succedaneum refers to edematous or hemorrhagic swelling under the skin
and above the galea aponeurosis. The mass is soft and indents with pressure.
Caput succedaneum are usually located at the vertex and cross the sutures
lines. They resolve rapidly and require no treatment. Subgaleal hemorrhages
are localized between the galea aponeurosis and the external periosteum.
They produce a mass that, as in caput
succedaneum, crosses the suture lines, but unlike
caput succedaneum, the mass feels tense and fluctuates with pressure.
Subgaleal hemorrhages may dissect over a large area of the skull.
No treatment is necessary unless blood loss into the subgaleal space
produces anemia and jaundice. Anemia and jaundice should be treated
if their severity warrants it.
Magnetic resonance imaging showing subgaleal hemorrhage. [B] Computed
tomography of the brain demonstrating caput succedaneum.