Is there bleeding in the newborn's head? Is this a subgaleal hemorrhage? Let's talk!

You must be very happy after your baby came into this world, right? But at the same time, sometimes you feel scared about small things. Especially if the delivery was a little difficult, it is normal to feel worried if you see such a small change in the baby's head. Today we are going to talk about a condition that can occur in the head at such a time, and you need to be a little careful.

What is this subgaleal hemorrhage? Let's understand it very simply!

Simply put, this is a collection of blood under the skin of a newborn baby's head, between the layers of soft tissue above the skull. Just think, our heads also have different layers under the skin. Similarly, under the skin of a baby's head, there is a membrane made of strong, fibrous connective tissue, which doctors call `(galea aponeurotica)`. Underneath that, there is another membrane around the bones of the skull, which is called `(periosteum)`. This bleeding, or blood collection, occurs between those two layers.

The main reason for this is that there are small blood vessels that connect from the scalp to the inside of the skull. These are called ``emissary veins``. These blood vessels travel through small holes (``foramen``) in the skull. Sometimes, during a difficult birth, these blood vessels can be pulled and ruptured when the baby comes out. That's when blood flows from there and collects in the said gap.

This can be a bit dangerous. Because, a significant amount of blood, between 20% and 40% of the baby's entire body, can accumulate in the head in this way. But don't worry, if this is recognized and treated promptly and promptly, it can be completely cured. This condition usually gets better in two to three weeks.

Who is most likely to get this condition?

This condition, called ``Subgaleal Hemorrhage``, is a very rare occurrence for any baby born through a normal vaginal delivery. However, when the baby is difficult to come out, doctors may need to use some equipment to help with the delivery. For example, if a ``vacuum extractor`` (we call it a 'vacuum' in conversation) or ``forceps`` (a device like forceps) is used, the risk is relatively higher.

How common is this situation? Should we be afraid?

Actually, this is a very rare condition. That is, it is not something that is seen often. This is reported in about 4 babies out of 10,000 normal deliveries without the use of equipment. Isn't that a very low number? However, as I said earlier, if a device like a ``vacuum extractor`` is used to remove the baby, this number increases a little. In such cases, medical reports say that about 60 babies out of 10,000 deliveries can develop this condition. But that is not the case for everyone.

Why does this subgaleal hemorrhage occur? What are the causes?

As I mentioned earlier, the main cause of this is when the small blood vessels (emissary veins) that go from the scalp to the skull break due to some pressure during childbirth. Then, that blood collects in the space between the skin and the skull (subgaleal space). This only happens during normal childbirth , this condition does not occur during a cesarean section.

Sometimes childbirth can be a little more complicated than we expect. That's when doctors have to use equipment like a ``vacuum extractor'' or ``forceps'' to safely remove the baby. Here are some reasons why childbirth can be difficult:

• The baby's head or body is too large to fit through the mother's pelvis. Doctors call this ``cephalopelvic disproportion''.
• The baby does not descend properly and safely through the birth canal (fetal dystocia).
• The baby's weight is much higher than normal (macrosomia).
• Prolonged labor is when the baby is not born for more than 20 hours after the start of labor.
• Sometimes, labor can come very quickly, in as little as three hours, and the baby is about to be born (`precipitous labor`). Sometimes problems can arise at this time as well.

This condition is most likely to occur when the baby is removed using a `(vacuum extractor)`. Because, when the cup-like part of the `(vacuum)` is attached to the baby's head, the pulling force it creates can pull the skin of the head away from the skull a little. Then the delicate connective tissue in the `(subgaleal space)` becomes loose, creating a space for blood to collect. If too much blood collects in this way, it can be life-threatening for the baby. That's why doctors are very careful about this.

What are the symptoms of this? How do you recognize it if you see it?

The symptoms of a ``Subgaleal Hemorrhage`` start to appear after the baby is born. Here are some things you can see:

• The baby's skin appears bruise-like , especially on the head and neck.
• Very fast heartbeat (tachycardia).
• Having low blood pressure.
• The skin color appears very pale (`pallor`).
• Due to the loss of a large amount of blood from the body, the levels of components in the blood called ``hemoglobin`` and ``hematocrit`` decrease.
• A swelling that feels like water on the baby's head (boggy swelling) occurs. This is caused by blood pooling inside. This swelling may also spread behind the baby's ears and onto the neck.

Fortunately, not all babies develop severe symptoms. Less than 25% of all cases of subgaleal hemorrhage develop symptoms that are severe enough to be life-threatening. These include:

• Excessive internal bleeding or problems with blood clotting (coagulopathy).
• A condition called `hypovolemic or hemorrhagic shock`, which occurs when the body loses too much fluid and blood to the point where the heart cannot pump blood properly.
• Difficulty breathing (respiratory distress).
• Insufficient oxygen supply to the brain during birth (intrapartum hypoxia).
• Gradual failure of internal organs, such as the kidneys (organ failure).

How do doctors diagnose this? What tests do they do?

As soon as the baby is born, the medical team will carefully examine the baby to see if they have any of the symptoms mentioned earlier. For example, they will look closely at the baby's skin to see if it is pale, the head is swollen, or if there are any unusual bruises.

If there is even the slightest suspicion of a ``Subgaleal Hemorrhage'', the doctor will order several special tests on the baby's head.

• An ultrasound of the head.
• Maybe a `(CT scan - Computed Tomography scan)`.
• Or an MRI (Magnetic Resonance Imaging).
• Sometimes an X-ray may be taken.

These tests can show exactly what the bleeding under the skin looks like and how big it is.

Imagine that a vacuum extractor was used to remove your baby. If that happens, even if your baby doesn't show any major symptoms right away, doctors will keep your baby in the nursery or, if necessary, the neonatal intensive care unit (NICU) for a few hours to monitor him closely. This is because sometimes this blood pooling and tissue damage that causes skin discoloration take time to develop. This means that these symptoms can appear anywhere from one hour to 72 hours (3 days) after the baby is born.

How can this be treated? Will the baby get well soon?

Once doctors confirm that it is a ``Subgaleal Hemorrhage'', they begin treatment immediately. This treatment is usually done in the neonatal intensive care unit (``NICU'') .

The main thing is to restore the baby's blood volume if it has decreased. This is done by giving the baby things like blood and plasma transfusions.

Additionally, the baby's medical team will continue to monitor the baby's blood levels (hemoglobin, hematocrit), heart rate, and blood pressure. The baby's head circumference will also be measured regularly to see if the swelling is decreasing or increasing.

Sometimes, if the bleeding is severe and cannot be controlled with fluid transfusions, emergency surgery may be necessary, very rarely. This is done to stop the bleeding from the bleeding area in the head and to remove the accumulated blood.

How quickly will the baby recover after treatment?

Once the bleeding stops with treatment, the swelling in the head gradually decreases and other symptoms disappear. These usually resolve within two to three weeks.

However, you should continue to stay in touch with your baby's doctors throughout the baby's first year, and go to the clinics and tests they recommend. This is to check if there are any other symptoms that could be affecting your baby's development. In most cases, about 75% of cases, if the treatment is successful, the baby will recover well and you will be able to go home with your baby.

Is there a way to reduce the occurrence of this kind of situation?

It is actually very difficult to completely prevent a ``Subgaleal Hemorrhage'' from occurring. This is because it often occurs as an unexpected result of a difficult delivery. Often, the presence of such a difficulty is only discovered during delivery.

However, it is important to get proper antenatal care and follow your doctor's instructions during your pregnancy. During prenatal ultrasounds, your doctor will look at the baby's position, size, and the size of your pelvis to determine if a normal delivery is the safest option for you and your baby, or if you should consider other options.

What happens if my baby has this condition? Should I be worried?

Unfortunately, a very small percentage of babies (between 10% and 25%) die in their early infancy due to excessive bleeding. This is sad to hear. However, more than 75% of babies diagnosed with ``Subgaleal Hemorrhage'' recover well and live normal lives. Early detection and treatment are the best ways to help your baby. That's why doctors are so vigilant about this.

How long will this subglottic hemorrhage last?

Usually, after treatment, your baby's symptoms of ``(Subgaleal Hemorrhage),'' especially the swelling of the head , will almost completely disappear within two to three weeks. Doctors will continue to monitor the baby's health even after he is discharged from the hospital. They will check to see if there have been any adverse reactions to the treatment, if the swelling has completely gone down, and if the baby's other organs are working properly.

How do you take care of a baby with this condition? You need to take care of yourself too!

Your newborn baby with a subgaleal hemorrhage will likely be kept in the NICU or special neonatal unit for a few days until the doctors decide that the baby is healthy and stable enough to be sent home.

Even after the baby comes home, it is essential to take him to the clinic appointments prescribed by the doctors during the first year. These tests are what confirm whether the treatment is successful and whether there are any other long-term problems that may arise due to this condition.

This is very important:When things are so stressful and overwhelming right after the birth of your baby, it's important for you as a mother to take care of yourself. This is not an easy time. Get support from your family, your husband, and your friends. If you are feeling stressed, anxious, sad, or scared, please talk to your doctor or midwife. Don't be shy about asking for help if you need it.

When should I see the doctor again?

After your baby comes home, see a doctor if you notice any of the following:

• If the swelling on the baby's head does not go down after treatment, remains the same or increases.
• If your baby's skin continues to be pale, or if the whites of their eyes or skin appear yellow (like jaundice).
• If your baby's developmental milestones - such as smiling, holding their neck, and rolling over - seem to be falling behind other babies in their first year,

When should you go to the hospital (ER) immediately?

If a baby who has had (or has) a ``Subgaleal Hemorrhage`` has a seizure, it is a medical emergency. A seizure can be anything from:

• The baby seems to lose consciousness for a while.
• My limbs are constantly twitching and shaking uncontrollably.
• The baby suddenly seems agitated, scared, or acts strangely.

A seizure usually lasts from 30 seconds to two minutes. However, if a seizure lasts more than five minutes, it is very dangerous. Especially if the baby is having difficulty breathing, call 911 immediately, or take the baby to the nearest hospital emergency room as soon as possible.

What should I ask my doctor?

At a time like this, you may have many questions on your mind. It may be helpful to ask your doctor these questions:

• "Doctor, how serious is my baby's condition?"
• "Does the baby need surgery for this? Or are there other treatments?"
• "When can I take the baby home from the hospital?"
• "Is there any special way I should take care of the baby after I get home?"

What is the difference between Hemorrhage and Hematoma?

You may have heard these two words. The word ``Subgaleal`` refers to where this condition occurs. That is, the space between the skin and the skull on the head.

• `Hemorrhage` means that there is still bleeding, or that bleeding continues, in the `subgaleal` area of ​​the head. That is, active bleeding.
• `Hematoma` means that blood has collected in one place and clotted . This means that the blood, which was liquid, has thickened a little and become like a lump.

In this ``Subgaleal Hemorrhage``, there is initially bleeding (hemorrhage), and then the blood can clot over time (hematoma). Both of these occur when the blood vessels in that area are damaged due to some injury or damage.

Finally, things you need to remember...

After a difficult delivery, as a mother, it is very normal to feel a lot of anxiety and stress as doctors rush to take action regarding your baby's health. At a time like this, it is very important to surround yourself with your family, husband, and friends for their love and support, rather than suffering alone. Share your feelings with them.

With prompt and careful treatment from the doctors, your baby has a better chance of a good outcome. As soon as your baby recovers in the hospital, you will be able to take him home with you in your loving embrace. So stay strong. Wishing you and your baby a speedy recovery!

` Subgaleal Hemorrhage, Newborns, Head Bleeding, Vacuum Delivery, Forceps Delivery, Birth Complications, Newborn Health