title: Life-threatening neonatal epidural hematoma caused by precipitous vaginal delivery.
abstract: BACKGROUND
  Neonatal in-hospital falls occur relatively frequently, although they are likely underreported. Significant intracranial head trauma from a fall or birth injury is not common in the immediate newborn period. Furthermore, intracranial bleeding requiring surgical intervention is exceedingly rare. We present an unusual case of an in-hospital fall in the delivery room requiring neurosurgical intervention.
  
  
  METHODS
  A term infant, appropriate for gestational age, delivered precipitously from a maternal standing position. The vertex neonate struck the linoleum floor after an approximate 80-cm fall, landing headfirst. The physical and neurological exams were initially normal, and skull films did not demonstrate an obvious fracture. The baby was closely observed, undergoing continuous cardiorespiratory monitoring. After the patient had an episode of apnea, a scalp hematoma was noted. A computed tomography (CT) scan revealed a left parietal fracture with an acute epidural hematoma, which required emergent craniotomy. The infant had an unremarkable post-operative course and had a normal neurodevelopmental assessment at 15 months of age.
  
  
  CONCLUSIONS
  Close, continuous observation is recommended for infants following an in-hospital fall or after significant birth trauma. A high degree of suspicion for intracranial hemorrhage must be maintained. Fall prevention strategies should focus on careful baby handling by the convalescing mother.
authors: Department of Pediatrics, Division of Neonatology, Saint Louis University, Saint Louis, MO, USA.
authors: Justin B
authors: JB
authors: Josephsen
authors: Department of Neurological Surgery, Division of Pediatric Neurosurgery, Saint Louis University, Saint Louis, MO, USA.
authors: Joanna
authors: J
authors: Kemp
authors: Department of Neurological Surgery, Division of Pediatric Neurosurgery, Saint Louis University, Saint Louis, MO, USA.
authors: Samer K
authors: SK
authors: Elbabaa
authors: Department of Pediatrics, Division of Neonatology, Saint Louis University, Saint Louis, MO, USA.
authors: Mohamad
authors: M
authors: Al-Hosni
mesh_terms: D000058:Accidental Falls; D000328:Adult; D001720:Birth Injuries / Q000150:complications* / Q000175:diagnosis; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009460:Neurologic Examination; D011247:Pregnancy; D014057:Tomography, X-Ray Computed
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