title: Severe neonatal subgaleal hemorrhage as the first presentation of hemophilia A.
abstract: BACKGROUND
  Subgaleal hemorrhage is a rare but potentially fatal birth trauma. It is caused by rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by the accumulation of blood between the epicranial aponeurosis and the periosteum. Usually, it is associated with instrumental delivery (vacuum extraction, forceps delivery), but it may also occur spontaneously, suggesting the possibility of congenital bleeding disorder.
  
  
  METHODS
  A full term male neonate was born at 40 weeks gestation by spontaneous vaginal delivery, with birth weight of 3,700 g. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. At the age of 23 hours, the baby became pale and lethargic. Large fluctuant swelling on his head was noted. He developed severe anemia and hypovolemia as a result of massive subgaleal hemorrhage. After successful treatment, the baby fully recovered. Follow-up and further evaluation revealed hemophilia A as a result of a de novo mutation.
  
  
  CONCLUSIONS
  This case illustrates that subgaleal hemorrhage may be the first presentation of hemophilia A. Infants without obvious risk factors for developing subgaleal hemorrhage should be evaluated for congenital bleeding disorder. Successful outcome in affected infants requires early diagnosis, careful monitoring and prompt treatment.
authors.forename: Tanja
authors.initials: T
authors.lastname: Radovanović
authors.forename: Slobodan
authors.initials: S
authors.lastname: Spasojević
authors.forename: Vesna
authors.initials: V
authors.lastname: Stojanović
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Doronjski
mesh_terms: D001034:Apgar Score; D001720:Birth Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D001724:Birth Weight; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D036861:Delivery, Obstetric; D005260:Female; D006467:Hemophilia A / Q000150:complications* / Q000175:diagnosis; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors; D012535:Scalp / Q000098:blood supply; D012771:Shock, Hemorrhagic / Q000209:etiology*; D012886:Skull / Q000098:blood supply