Das subgaleale Hämatom beim Neugeborenen – ein neonatologischer Notfall

ZUSAMMENFASSUNG

Das subgaleale Hämatom (SGH) ist eine seltene Geburtskomplikation des Neugeborenen und kann aufgrund des erheblichen Blutverlustes in den subgalealen Raum zu einem hämorrhagischen Schock führen. Wir berichten von zwei Neugeborenen, die ein subgaleales Hämatom mit schwerem hämorrhagischem Schock und Enzephalopathie entwickelten. Im ersten Fall eines reifen weiblichen Neugeborenen wurde die Entstehung des subgalealen Hämatoms durch eine Neugeboreneninfektion und die Geburt mittels Vakuumextraktion begünstigt. Der zweite Fall eines männlichen Frühgeborenen wurde durch eine schwierige Kindsentwicklung mittels sekundärer Sectio caesarea kompliziert. Neben der raschen Behandlung des Schocks ist vor allem die Therapie der Gerinnungsstörung essentiell. Beide Fälle verdeutlichen, dass das subgaleale Hämatom ein neonatologischer Notfall ist.

Abstract

Subgaleal hematoma (SGH) is a rare complication in neonates that may lead to hemorrhagic shock due to significant blood loss into the subgaleal space. We report of two neonates who developed subgaleal hematoma with severe hemorrhagic shock and encephalopathy. In the first case of a mature female neonate, the development of the subgaleal hematoma was promoted by early-onset sepsis and delivery by vacuum extraction. The second case, of a male preterm neonate, was a complicated fetal development followed by secondary cesarean section. Both cases highlight that a subgaleal hematoma is a severe neonatal emergency. In addition to prompt treatment of the shock, therapy of the coagulopathy is essential.

Schlüsselwörter

Neugeborenes - Subgaleales Hämatom - Geburtsverletzungen - Hämorrhagischer Schock - Koagulopathie

Key words

Newborn - Subgaleal hematoma - Birth injuries - Hemorrhagic shock - Coagulopathy

Publication History

Received: 12 February 2021

Accepted after revision: 19 April 2021

Article published online:
01 July 2021

• Literatur

• 1 Ellis H, Mahadevan V. The surgical anatomy of the scalp. Surgery (Oxford) 32 (01) 2014; 1-5
• 2 Colditz MJ, Lai MM, Cartwright DW. et al. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health 2015; 51: 140-146
• 3 Robinson RJ, Rossiter MA. Massive subaponeurotic haemorrhage in babies of African origin. Arch Dis Child 1968; 43: 684-687.
• 4 Eliachar E, Bret AJ, Bardiaux M. et al. Cranial subcutaneous hematoma in the newborn. Arch Fr Pediatr 1963; 20: 1105-11
• 5 Plauché WC. Subgaleal hematoma. A complication of instrumental delivery. JAMA. 1980; 244 (14) 1597-1598
• 6 Kilani RA, Wetmore J. Neonatal subgaleal hematoma: presentation and outcome—radiological findings and factors associated with mortality. Am J Perinatol 2006; 23 (01) 41-48.
• 7 Chadwick LM, Pemberton PJ, Kurinczuk JJ. Neonatal subgaleal haematoma: associated risk factors, complications and outcome. J Paediatr Child Health 1996; 32: 228-232.
• 8 Swanson AE, Veldman A, Wallace EM. et al. Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand 2012; 91: 260-263
• 9 Boo NY, Foong KW, Mahdy ZA. et al. Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. BJOG 2005; 112: 1516-1521
• 10 Gebremariam A. Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors. Ann Trop Paediatr 1999; 19: 45-50.
• 11 Levin G, Elchalal U, Yagel S. et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98: 1464-1472.
• 12 Boo NY. Subaponeurotic haemorrhage in Malaysian neonates. Singapore Med J. 1990; 31: 207-210
• 13 Govaert P, Vanhaesebrouck P, De Praeter C. et al. Vacuum extraction, bone injury and neonatal subgaleal bleeding. Eur J Pediatr 1992; 151: 532-535.
• 14 Chang HY, Peng CC, Kao HA. et al. Neonatal subgaleal hemorrhage: clinical presentation, treatment, and predictors of poor prognosis. Pediatr Int 2007; 49: 903-907.
• 15 Åberg K, Norman M, Ekéus C. Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study. BMC Pregnancy Childbirth 2014; 14: 42.
• 16 Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ. 2001; 164: 1452-1453
• 17 Annane D, Siami S, Jaber S. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial [published correction appears in JAMA. 2013; 311: 1071. Régnier, Jean [corrected to Reignier, Jean]; Cle’h, Christophe [corrected to Clec’h, Christophe]. JAMA 2013; 310: 1809-1817
• 18 Polites SF, Nygaard RM, Reddy PN. et al. Multicenter study of crystalloid boluses and transfusion in pediatric trauma-When to go to blood?. J Trauma Acute Care Surg 2018; 85: 108-112
• 19 Rieger-Fackeldey E, Aslan I, Burdach S. Hämorrhagischer Schock im frühen Kindesalter – Besonderheiten der Kreislaufregulation. Monatsschr Kinderheilkd 166: 949-958 2018;
• 20 Wyckoff MH, Weiner CGM. Neonatal Life Support Collaborators. 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics 2021; 147: e2020038505C
• 21 Holcomb JB, Tilley BC, Baraniuk S. et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015; 313: 471-482
• 22 Haas T, Cushing MM. Hemostatic Balance in Severe Trauma. Front Pediatr 2020; 8: 600501.
• 23 Grottke O, Mallaiah S, Karkouti K. et al. Fibrinogen Supplementation and Its Indications. Semin Thromb Hemost 2020; 46: 38-49.
• 24 Strauss T, Kenet G, Schushan-Eisen I, Mazkereth R, Kuint J. Rescue recombinant activated factor VII for neonatal subgaleal hemorrhage. Isr Med Assoc J 2009; 11: 639-640
• 25 Hünseler C, Kribs A, Eifinger F. et al. Recombinant activated factor seven in acute life-threatening bleeding in neonates: report on three cases and review of literature. J Perinatol 2006; 26: 706-713