Subgaleal Hemorrhage as a Cause of Anemia in Newborn: Case Report

Background: Subgaleal hemorrhage(SGH) is a rare but serious birth-related adverse event that, when unrecognized, can result with death. It is caused by rupture of the emissary veins, which are connections between the dural sinuses and the scalp veins. The incidence rate is reported to be approximately 0.04% in spontaneous delivery and 0.6% in vacuum extraction.

Case: A 32-year-old mother with a normal vaginal route delivery of the second pregnancy of a 40-week-old male infant was born with vaginal delivery without any intervention such as vacuum extraction. First and fifth minute Apgar score was evaluated as 6 and 9 respectively. His body weight was 3890 gr. On first day, he had hypoactivity, pallor, swelling extending to the occipital region and decreased ineonatal reflexes. He had tachycardia, tachypnea and hypotension. The patient was hospitalized in the neonatal intensive care unit. He had anemia(Hb:8.8g/dL) and metabolic acidosis. He had no hemolysis and no thrombocytopenia. aPTT, INR, PT and fibrinogen levels were. In cranial ultrasonography a radiolucent appearance of 2-3 cm wide was found between the periosteum and the scalp. Cranial computed tomography revealed widespread subgaleal hemorrhage. Surgical intervention was not considered and in the follow-up, erythrocyte suspension was transfused twice. All medications were discontinued and the patient was discharged on postnatal 15th day with 3975 g of body weight.

Conclusion: Although it usually has a good prognosis, it can lead to serious complications and death. For this reason, rapid diagnosis, close monitoring and supportive treatment are important. Diagnostic cranial USG is insufficient to detect intracranial pathologies. Cranial CT or MRI should be preferred in the patient with clinical findings independent of the severity of SGH. Severe hypovolemia and coagulopathy are the most important factors affecting mortality and should be treated aggressively. Patients with SGH should be monitored for short and long-term complications.