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Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations

Journal of Perinatology volume 45, pages 167–179 (2025)Cite this article

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Abstract

Subgaleal hemorrhages (SH) involve bleeding in the expansive compartment between the periosteum of the skull and the galea aponeurotica. The potentially rapid accumulation of blood in this space is responsible for the clinical severity, as neonates with SH can present with acute hypovolemia, shock and multiorgan failure. SH is associated with instrumented delivery, especially with use of vacuum extraction. Although infrequent, the incidence of SH has not decreased over the past several decades, despite improvements in obstetrical care. Management of severe SH is complex and requires cardiovascular support, management of co-existent encephalopathy, and most importantly correction of coagulopathy and anemia.

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Fig. 1: Anatomical structures (black color) related to SH, with associated mechanisms (green color). Synchondrosal rupture, skull fracture and venous injury have all been reported.

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Acknowledgements

We would like to acknowledge the Crystal Charity Ball and the NeuroNICU program at the University of Texas Southwestern Medical Center for supporting this project. Figure 1 was created by Spyridoula Angeli, a high school student. For accuracy of anatomical structures, illustrations from Netter’s Atlas of Anatomy and Sobotta Human Atlas of Anatomy as well as various radiographic images were used.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kikelomo Babata, Nicole A. Bailey, Shamaila Gill, Rachel Leon & Dimitrios Angelis

  2. Department of Obstetrics and Gynecology, Maternal Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Gayathri Vadlamudi

  3. University of Texas Southwestern Medical Center, Medical School, Dallas, TX, USA

    Pranav Viswanathan

  4. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Rafael Sillero

  5. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Tina Seidu

  6. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kate Louise Mangona

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  1. Kikelomo Babata
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Contributions

DA contributed to the concept of the paper, wrote the initial and revised drafts of this manuscript, and approved the final manuscript as submitted. KB critically reviewed the manuscript and approved it as submitted. GV, NB, SG, PV, RS, TS, KM, and RL contributed equally to the conceptualization of the paper, reviewed, and revised the manuscript, and approved the final manuscript as submitted. TS is a first-year neonatology fellow, while PV is a medical student at University of Texas, Southwestern Medical Center.

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Correspondence to Dimitrios Angelis.

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Babata, K., Vadlamudi, G., Bailey, N.A. et al. Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations. J Perinatol 45, 167–179 (2025). https://doi.org/10.1038/s41372-024-02116-w

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