In the NICU, we see many babies who have suffered some form of head trauma or injury during birth. One of the most common types being Caput Succedaneum!
What Is It?
Caput succedaneum—caput, for short—is the formal medical term for the area of localized swelling or edema which is commonly present on the head of a newborn following vaginal delivery. This is a very common and usually benign neonatal condition resulting from normal pressure and compression on the baby's head as it passes through the birth canal. Caput itself is harmless and merely indicates that the baby went through a particularly difficult and stressful delivery. The swelling is limited to the scalp and is not a symptom of a deeper injury to the skull or brain. Although caput is nothing to worry about and quickly resolves, it can lead to other complications including jaundice or hydrocephalus.
Which Babies Are at Higher Risk?
In a normal vaginal delivery, the baby is pushed through the birth canal head first. This makes the top of the head the focal point of significant pressure as the baby progresses through the very narrow birth canal. These pressures are greater for babies that are large for gestational age and have a higher-than-normal birth weight (also known as macrosomic babies). Babies who undergo a prolonged, difficult birth are also at risk. Caput can also be triggered by the use of a vacuum extractor or forceps to facilitate a vaginal delivery.
What are the Symptoms?
The primary symptom of caput is a boggy, swollen, puffy, soft spot on the top of the baby’s head just under the skin of the scalp. The area may appear on one particular side or extend across the middle of the scalp.
What is the Treatment?
Caput is not a medical emergency nor is it usually a condition that requires any treatment. The baby will almost always make a complete recovery after just a few short days.
Is Caput the Same as Cephalohematoma?
No! The difference between the two stems down to location and type of bleeding. In cephalohematoma, serosanguineous fluid (blood) is collected between the periosteum of the skull and the skull bone itself, so it does not cross suture lines. In other words, cephalohematoma occurs in a deeper, more vascular portion of the scalp. This type of bleed is very slow in nature; signs and symptoms are not usually present at birth and develop hours-to-days after delivery. A firm, enlarged unilateral or bilateral bump covering one or more bones of the scalp characterizes the lesion. Cranial sutures clearly define the boundaries of the cephalohematoma, compared to caput which can cross the suture line. In comparison, caput involves diffuse swelling of the scalp, with subcutaneous fluid collection unrelated to the periosteum with poorly defined margins. Additionally, caput succedaneum is a highly common birth injury while cephalohematomas are very rare.
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