Infected cephalohematomas and underlying osteomyelitis: a case-based review

Cephalohematomas are relatively common sub-periosteal collections of blood that tend to resolve spontaneously without treatment. Rarely, they become infected and can be associated with underlying osteomyelitis, meningitis, or sepsis. Common pathogens include Escherichia coli and Staphylococcus species.

This report describes the first case of a neonate developing an infected right parietal cephalohematoma and underlying osteomyelitis caused by Morganella morganii, which was cultured in blood and cephalohematoma aspirate. This infant male, whose risk factors included vacuum extraction during delivery and suspected post-natal pneumonia, responded well to a 6-week course of intravenous meropenem with complete resolution of both lesions.

When an infected cephalohematoma is suspected, aspiration of hematoma fluid should be performed for both diagnostic and therapeutic purposes. Infectious symptoms should warrant prompt investigation and treatment, which may include drainage, debridement, and antibiotics. This report demonstrates that the combination of an infected cephalohematoma and underlying osteomyelitis might not be as uncommon as previously believed.