Risk factors for subgaleal hemorrhage and adverse early neonatal outcomes: a single-center cohort study with...

Subgaleal hemorrhage (SGH) in neonates ranges from benign bleeds to life-threatening shock. Even small SGH may be linked with parenchymal brain injury and hypoxic-ischemic insult. This study aimed to characterize clinical and neuroimaging features of SGH and identify predictors of early abnormal outcomes or death.

We retrospectively reviewed all SGH cases admitted to a high-volume Dallas NICU over 11 years, where forceps are exclusively used for operative vaginal deliveries. Data included demographics, clinical and laboratory findings, neuroimaging, and outcomes. Severe outcome was defined as abnormal neurologic exam at discharge, seizures, encephalopathy, or death.

Among 141,448 live births, 43 neonates required further care in the NICU for SGH (approximate incidence: 3 per 10,000 live births). Of these, two infants died, and 23% experienced severe outcomes. Volume expansion and metabolic acidosis predicted severity. MRI identified additional lesions not evident on ultrasound.

SGH requiring NICU care may signal broader neurologic injury. MRI aids diagnosis, while exclusive forceps use was associated with lower SGH incidence and mortality.