Neonatal subgaleal hemorrhage: clinical presentation, treatment, and predictors of poor prognosis.
BACKGROUND
Neonatal subgaleal hemorrhage (SGH) is a rare but potentially lethal medical emergency. The objective of the present retrospective study was to clarify the clinical presentation, management, and factors associated with morbidity and mortality.


METHODS
The records of all newborns from January 1995 to December 2004 were reviewed for evidence of SGH, based on the presence of a fluctuating hemorrhagic mass that crossed suture lines and extended toward the neck. Characteristics were compared between those with a poor or a good outcome.


RESULTS
Forty-two newborns with SGH were identified, 77% having had an instrumental delivery. The incidence was 0.6/1000 deliveries and 4.6/1000 vacuum-assisted deliveries. Thirteen patients (31%) had a poor outcome (five died, four had epilepsy, three with severe auditory dysfunction, two with cerebral palsy, and one with renal vein thrombosis). The group with the poor outcome had significantly more patients who had been transferred from other hospitals (P < 0.001). Those with a poor outcome had significantly more hypotension (P < 0.001) and seizures (P < 0.05). Laboratory findings associated with a poor outcome included anemia, coagulopathy, metabolic acidosis, and renal impairment. Other predictors of a poor prognosis included skull bone fracture, the need for pressors, blood transfusion, ventilator support, intensive care unit admission, and a longer hospital stay.


CONCLUSIONS
SGH may be associated with serious complications and death. The condition must be recognized promptly and monitored closely. Those with poor prognostic factors should be referred for intensive care, treated aggressively, and followed in the long term.
Chang
Hung-Yang
HY
Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan. a4583@ms7.mmh.org.tw
Peng
Chun-Chih
CC
Kao
Hsin-An
HA
Hsu
Chyong-Hsin
CH
Hung
Han-Yang
HY
Chang
Jui-Hsing
JH
D001720:Birth Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010521:Periosteum; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*