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Early needle aspiration of large infant cephalohematoma: a safe procedure to avoid esthetic complications
Fabian Blanc1, Michèle Bigorre2, Audrey Lamouroux3
1Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, 371 avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
Insights
Early puncture of large cephalohematoma in newborns is safe and effective. This procedure, performed between 15 and 30 days, reduces the risk of persistent skull deformities and unesthetic outcomes.
Area of Science:
- Neonatal care
- Pediatric surgery
- Medical diagnostics
Background:
- Cephalohematoma is a common newborn condition, typically resolving spontaneously.
- Large cephalohematomas can lead to cosmetic deformities and potential complications like calcification if not managed.
- Current management for large cases is often observational, risking long-term esthetic issues.
Purpose of the Study:
- To evaluate the iatrogenic risks of early puncture for large cephalohematoma.
- To assess the safety and efficacy of needle aspiration under local anesthesia and oral sucrose.
- To determine optimal timing for intervention to prevent calcification and deformity.
Main Methods:
- Retrospective study of 67 newborns with large cephalohematoma (2010-2017).
- Puncture performed between 15 and 30 days of life after coagulation and ultrasound assessment.
- Intervention utilized local anesthesia and oral sucrose for pain management.
Main Results:
- Puncture was performed on 67 newborns (64% male) between 15 and 30 days post-birth.
- Ultrasound measurements showed maximal projection ranging from 9 to 13 mm.
- No complications related to the puncture procedure were observed during intervention or follow-up.
Conclusions:
- Early puncture is a safe and effective treatment for large, persistent cephalohematomas.
- The procedure, performed between 15 and 30 days, mitigates risks of calcification and skull deformity.
- This intervention offers a rapid solution for unesthetic cephalohematoma, improving cosmetic outcomes.
Abstract:
Cephalohematoma is a common pathology in newborns. Observation is the primary treatment for most patients with small uncomplicated cephalohematoma. Conversely, a large cephalohematoma can lead to calcification with unesthetic local deformation or deformational plagiocephaly. The objective of the study was to evaluate the iatrogenic risk associated with early puncture under local anesthesia and oral sucrose. This is a retrospective study of 67 consecutive newborns followed at Montpellier University Hospital, France, between 2010 and 2017. Large cephalohematoma was defined on the basis of the bump projection. Due to the uncertainty of the spontaneous resorption and the risk of calcification after 4 weeks which render the needle aspiration ineffective, puncture was performed between 2 and 4 weeks of life after coagulation evaluation and ultrasound of the skull and scalp. Puncture was performed in 43 boys (64%) and 24 (36%) girls between day 15 and day 30 after birth. The cephalohematoma maximal projection measured by ultrasound ranged from 9 to 13 mm (Q1,Q4) with a median value of 12 mm. No puncture-related complication was recorded during the intervention and at the 1-month follow-up visit.Conclusion: In newborns with large and persistent unesthetic cephalohematoma, puncture under local anesthesia with oral sucrose can be safely proposed between day 15 and day 30 after birth.What is Known:• Infant cephalohematoma is a frequent pathology of newborns, consisting of a traumatic subperiosteal hematoma of the skull. Most cephalohematomas are small and require no treatment because they spontaneously disappear within the first month.• Large and non-resorptive cephalohematomas may have significant esthetic and functional consequences.What is New:• Early puncture under local anesthesia is a safe, effective, and rapid procedure, decreasing the risk of persistent skull deformities.• Puncture can be proposed for newborns with a large (high projection and/or high angle connection) persistent anesthetic cephalohematoma, between day 15 and day 30, before spontaneous calcification.
