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Head Trauma
Head 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.
The 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.


Figure 106.1.[A] Magnetic resonance imaging showing subgaleal hemorrhage. [B] Computed tomography of the brain demonstrating caput succedaneum.


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