Subgaleal hemorrhage (SGH) in the newborn can be associated with either a benign or complicated postnatal course.
Anatomy: The galeal aponeurosis is a dense fibrous layer that runs between the frontal and occipital bellies of the occipitofrontal muscles. It runs between the subcutaneous tissue of the scalp and the cranial periosteum.
The hemorrhage in SH is due to rupture of the emissary veins between the dural sinuses and scalp veins.
Features:
(1) scalp swelling which may be extensive
(2) The hemorrhage is not constrained by suture lines and can spread over a large area, reaching the orbits anteriorly and the nuchal ridge posteriorly.
Risk factors for subgaleal hemorrhage:
(1) birth trauma, including forceps or vacuum extraction
(2) coagulopathy (hereditary factor deficiency, thrombocytopenia, other)
Ultrasound used to distinguish from cephalohematoma and caput succedaneum.
Findings associated with a poor outcome:
(1) metabolic acidosis
(2) severe encephalopathy
(3) severe hemorrhage requiring transfusion
(4) hemodynamic instability
(5) low Apgar score
(6) seizures
Low-grade hemorrhage may be associated with delayed recognition.
