[Neonatal subgaleal haemorrhage; a potential life-threatening extracranial haemorrhage]

A female neonate delivered at term developed hypovolemic shock due to a subgaleal haemorrhage, i.e. extracranial bleeding between the galea aponeurotica and the cranial periosteum. The subgaleal haemorrhage was most likely the result of a traumatic vacuum extraction. The patient was treated with large volumes of fluids and blood products and received additional circulatory and respiratory support. The clinical features of neonatal subgaleal haemorrhage are different from other, more common causes of head swelling in neonates. Subgaleal haemorrhage is characterised by a progressive, diffuse, mobile, elastic swelling that is not confined by the sutures. In contrast, cephalic haematoma is a fixed, elastic swelling that is confined by the sutures. Caput succedaneum is a soft, poorly defined swelling that is immediately visible post partum. Traumatic vacuum extraction clearly increases the risk of developing subgaleal haemorrhage. Given the high mortality associated with subgaleal haemorrhage, we emphasise the importance of early diagnosis and adequate treatment of this disorder. Subgaleal haemorrhage carries an increased risk of having other concurrent disorders, such as intracranial haemorrhage. Therefore, further cerebral imaging should be considered in patients with subgaleal haemorrhage.