Subgaleal hemorrhage in the newborn infant associated with silicone elastomer vacuum extractor

Subgaleal hemorrhage in the newborn infant has been reported worldwide, but despite the efforts of previous authors, this entity has not received the necessary attention in pediatric literature, and continues to represent a potentially fatal problem. Although the association of subgaleal hemorrhage with the use of the metal cup vacuum extractor has clearly been documented, its association with the silicone elastomer version has not been previously reported. We describe two cases in newborn infants where silicone elastomer cup vacuum extractor was used. The diagnosis of subgaleal hemorrhage must be considered in any infant with a scalp swelling and a falling hematocrit, and coagulation studies should be performed in all infants with a diagnosis of subgaleal hemorrhage. Complications include shock and death if subgaleal hemorrhage is massive and acute, and anemia and hyperbilirubinemia if it is slowly progressive. The familiarity with and ability of care givers to recognize the signs and symptoms of subgaleal hemorrhage are essential in preventing fatalities. A systematic approach to diagnosis with close monitoring of vital signs, hematocrit, blood gases, head circumference, and signs of tissue hypoperfusion is recommended for infants after instrument deliveries. Pathogenesis of this lesion needs to be emphasized in pediatric literature so that early recognition and prompt treatment may avoid a fatal outcome.