A 6-month-old comatose infant has multiple broken bones in various stages of healing, a bulging anterior fontanelle, and retinal hemorrhages. For the mentioned description of head injury that follows, select the major abnormality with which it is most likely to be associated.
A subgaleal or subaponeurotic hemorrhage can be life threatening; infants may lose a third or more of their blood volume into this potential space, leading to hypovolemic shock. A subgaleal hemorrhage will feel like a cephalohematoma that crosses the midline. Careful monitoring is essential.Subdural hematomas are commonly seen as part of abusive head trauma, formerly known as shaken baby syndrome. This lesion occurs when the bridging cortical veins that drain the cerebral cortex have been ruptured, leading to a collection of blood between the dura and the cerebral mantle. Repeated trauma can lead to additional collections of blood. In many children, additional findings of abuse such as broken bones, bruises, and retinal hemorrhages are found.Caput succedaneum is soft-tissue swelling of the scalp involving the presenting delivery portion of the head. This lesion is sometimes ecchymotic and can extend across the suture lines. The edema may be pitting, and resolves in the first few days of life.Intraventricular hemorrhage (IVH), also known as germinal matrix hemorrhage, is commonly seen in very small, preterm infants. The incidence of IVH increases with smaller-size infants and in those with perinatal complications. It occurs in the gelatinous subependymal germinal matrix of the brain and can lead to progressive posthemorrhagic hydrocephalus. Hydrocephalus in these children can present with enlarging head circumference, apnea and bradycardia, lethargy, bulging fontanelle, widely split sutures, or no signs at all. Therapy can include ventricular- peritoneal shunting.Cephalohematomas do not cross the suture line, since they are subperiosteal hemorrhages. No discoloration of the scalp is seen, and the swelling usually progresses over the first few hours of life. Occasionally, skull fractures are present as well. Most cephalohematomas resolve within the first few weeks or months of life without residual findings.
Intraventricular hemorrhage
Caput succedaneum
Subdural hemorrhage
Subarachnoid hemorrhage
New Born Infants