Abstract
Background
Cephalohematomas are relatively common sub-periosteal collections of blood that tend to resolve spontaneously without treatment. Rarely, they become infected and can be associated with underlying osteomyelitis, meningitis, or sepsis. Common pathogens include Escherichia coli and Staphylococcus species.
Illustrative case
This report describes the first case of a neonate developing an infected right parietal cephalohematoma and underlying osteomyelitis caused by Morganella morganii, which was cultured in blood and cephalohematoma aspirate. This infant male, whose risk factors included vacuum extraction during delivery and suspected post-natal pneumonia, responded well to a 6-week course of intravenous meropenem with complete resolution of both lesions.
Conclusion
When an infected cephalohematoma is suspected, aspiration of hematoma fluid should be performed for both diagnostic and therapeutic purposes. Infectious symptoms should warrant prompt investigation and treatment, which may include drainage, debridement, and antibiotics. This report demonstrates that the combination of an infected cephalohematoma and underlying osteomyelitis might not be as uncommon as previously believed.
Similar content being viewed by others
References
Karagol BS, Zenciroglu A, Kundak AA, Okumus N, Aydin M, Uner C (2010) A linear fracture and meningitis associated with non-infected cephalohematoma in a neonate. Neuropediatrics 41:276–278
Broekhuizen FF, Washington JM, Johnson F, Hamilton PR (1987) Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984. Obstet Gynecol 69:338–342
Dahl KM, Barry J, DeBiasi RL (2002) Escherichia hermannii infection of a cephalohematoma: case report, review of the literature, and description of a novel invasive pathogen. Clin Infect Dis Off Publ Infect Dis Soc Am 35:e96–e98
Kao HC, Huang YC, Lin TY (1999) Infected cephalohematoma associated with sepsis and skull osteomyelitis: report of one case. Am J Perinatol 16:459–462
Ghali S, Knox KR, Boutros S, Thorne CH, McCarthy JG (2007) The incidence of late cephalohematoma following craniofacial surgery. Plast Reconstr Surg 120:1004–1008
Blom NA, Vreede WB (1993) Infected cephalhematomas associated with osteomyelitis, sepsis and meningitis. Pediatr Infect Dis J 12:1015–1017
Kersten CM, Moellering CM, Mato S (2008) Spontaneous drainage of neonatal cephalohematoma: a delayed complication of scalp abscess. Clin Pediatr 47:183–185
Weiss KJ, Edwards MS, Hay LM, Allen CH (2009) Escherichia coli-infected cephalohematoma in an infant. Clin Pediatr 48:763–766
Meigs JF, Pepper W (1877) A practical treatise on the diseases of children. Lindsay & Blakiston, Philadelphia
Goodwin MD, Persing JA, Duncan CC, Shin JH (2000) Spontaneously infected cephalohematoma: case report and review of the literature. J Craniofac Surg 11:371–375 discussion
Brook I (2005) Infected neonatal cephalohematomas caused by anaerobic bacteria. J Perinat Med 33:255–258
Chang HY, Chiu NC, Huang FY, Kao HA, Hsu CH, Hung HY (2005) Infected cephalohematoma of newborns: experience in a medical center in Taiwan. Pediatr Int Off J Japan Pediatr Soc 47:274–277
Burry VF, Hellerstein S (1966) Septicemia and subperiosteal cepbalbematomas. J Pediatr 69:1133–1135
Cohen SM, Miller BW, Orris HW (1947) Meningitis complicating cephalhematoma. J Pediatr 30:327–329
Sjövall A (1936) Le céphalhématome des nouveau-nés. Acta Obstet Gynecol Scand 15:443–474
Chan MC, Boon WH (1972) Infected cephalhaematoma. J Singapore Paediatr Soc 14:57–60
Chen MH, Yang JC, Huang JS (2006) MRI features of an infected cephalhaematoma in a neonate. J Clin Neurosci Off J Neurosurg Soc Australas 13:849–852
Ellis SS, Montgomery JR, Wagner M, Hill RM (1974) Osteomyelitis complicating neonatal cephalhematoma. Am J Dis Child 127:100–102
Fan HC, Hua YM, Juan CJ, Fang YM, Cheng SN, Wang CC (2002) Infected cephalohematoma associated with sepsis and scalp cellulitis: a case report. J Microbiol Immunol Infect Wei mian yu gan ran za zhi 35:125–128
Gordon HS, Aronow J (1955) Escherichia coli meningitis in five-day-old infant; report of a case with complete recovery. J Am Med Assoc 159:1288–1289
Handrick W, Huckel D, Spencker FB, Kuhnert C (1983) Infected scalp hematoma. Zentralblatt fur Gynakologie 105:1011–1013
Hegde HR (1980) Infected cephalhematoma associated with placement of scalp electrode. Can Med Assoc J 122:876–878
Huang CS, Cheng KJ, Huang CB (2002) Infected cephalohematoma complicated with meningitis: report of one case. Acta paediatr Taiwan Taiwan er ke yi xue hui za zhi 43:217–219
Lee PY (1990) Infected cephalhaematoma and neonatal osteomyelitis. The Journal of infection 21:191–193
Levy HL, O’Connor JF, Ingall D (1967) Bacteremia, infected cephalhematoma, and osteomyelitis of the skull in a newborn. Am J Dis Child 114:649–651
Meignier M, Renaud P, Robert R, Roze JC, Rigal E, Mouzard A (1989) Cephalhematoma infection in neonatal septicemia. Pediatrie 44:27–29
Nakwan N, Wannaro J, Dissaneevate P, Kritsaneepaiboon S, Chokephaibulkit K (2011) Septicemia, meningitis, and skull osteomyelitis complicating infected cephalhematoma caused by ESBL-producing Escherichia coli. Southeast Asian J Trop Med Public health 42:148–151
Tan KL (1972) Infected cephalhaematoma. Aust Paediatr J 8:107–110
Wong CS, Cheah FC (2012) Cephalhematoma infected by Escherichia coli presenting as an extensive scalp abscess. J Pediatr Surg 47:2336–2340
Fleming H (1925) Osteomyelitis of the skull. Calif West Med 23:985–988
Overturf GD, Balfour G (1975) Osteomyelitis and sepsis: severe complications of fetal monitoring. Pediatrics 55:244–247
Lee Y, Berg RB (1971) Cephalhematoma infected with Bacteroides. Am J Dis Child 121:77–78
Listinsky JL, Wood BP, Ekholm SE (1986) Parietal osteomyelitis and epidural abscess: a delayed complication of fetal monitoring. Pediatr Radiol 16:150–151
Diwan N, Sharma KB (1978) Isolation of Salmonella typhimurium from cephalhematoma and osteomyelitis. Indian J Med Res 67:27–29
Falagas ME, Kavvadia PK, Mantadakis E, Kofteridis DP, Bliziotis IA, Saloustros E, Maraki S, Samonis G (2006) Morganella morganii infections in a general tertiary hospital. Infection 34:315–321
McDermott C, Mylotte JM (1984) Morganella morganii: epidemiology of bacteremic disease. Infect Control: IC 5:131–137
Lee IK, Liu JW (2006) Clinical characteristics and risk factors for mortality in Morganella morganii bacteremia. J Microbiol Immunol Infect Wei mian yu gan ran za zhi 39:328–334
Koyuncu S, Ozan F (2012) Morganella morganii osteomyelitis complicated by secondary septic knee arthritis: a case report. Acta Orthop Traumatol Turc 46:464–467
Smithson Amat A, Perello Carbonell R, Arenillas Rocha L, Soriano Viladomiu A (2004) [Osteomyelitis of the rib due to Morganella morganii]. An Med Interna 21:464
Miedema CJ, Ruige M, Kimpen JL (1999) Primarily infected cephalhematoma and osteomyelitis in a newborn. Eur J Med Res 4:8–10
Mohon RT, Mehalic TF, Grimes CK, Philip AG (1986) Infected cephalhematoma and neonatal osteomyelitis of the skull. Pediatr Infect Dis 5:253–256
Nightingale LM, Eaton CB, Fruehan AE, Waldman JB, Clark WB, Lepow ML (1986) Cephalhematoma complicated by osteomyelitis presumed due to Gardnerella vaginalis. JAMA 256:1936–1937
Van Helleputte C, Dupont V, Barthels S, Aeby A (2010) Escherichia coli meningitis and parietal osteomyelitis in an infant: a rare complication of cephalohematoma. Revue medicale de Bruxelles 31:57–59
Milligan KL, Barenkamp SJ (2013) Neonatal meningitis due to Morganella morganii. Clin Pediatr 52:462–464
Sinha AK, Kempley ST, Price E, Sharma BK, Livermore DM (2006) Early onset Morganella morganii sepsis in a newborn infant with emergence of cephalosporin resistance caused by depression of AMPC beta-lactamase production. Pediatr Infect Dis J 25:376–377
Verboon-Maciolek M, Vandertop WP, Peters AC, Roord JJ, Geelen SP (1995) Neonatal brain abscess caused by Morganella morgagni. Clin Infect Dis Off Publ Infect Dis Soc Am 20:471
Ndiaye M, Sene MS, Sow AD, Seck LB, Coulibaly T, Diagne NS, Toure K, Diop AG, Ndiaye MM (2010) Meningoencephalitis due to Morganella morganii: a case report. Bull Soc Pathol Exot 103:230–232
Chang HY, Wang SM, Chiu NC, Chung HY, Wang HK (2011) Neonatal Morganella morganii sepsis: a case report and review of the literature. Pediatr Int Off J Japan Pediatric Soc 53:121–123
Ovalle A, Martinez MA, Kakarieka E, Garcia M, Salinas A (2009) Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case. Revista medica de Chile 137:1201–1204
Dutta S, Narang A (2004) Early onset neonatal sepsis due to Morganella morganii. Indian Pediatr 41:1155–1157
Boussemart T, Piet-Duroux S, Manouana M, Azi M, Perez JM, Port-Lis M (2004) Morganella morganii and early-onset neonatal infection. Arch pediatr organe officiel de la Societe francaise de pediatrie 11:37–39
Casanova-Roman M, Sanchez-Porto A, Casanova-Bellido M (2002) Early-onset neonatal sepsis caused by vertical transmission of Morganella morganii. Scand J Infect Dis 34:534–535
Ranu SS, Valencia GB, Piecuch S (1999) Fatal early onset infection in an extremely low birth weight infant due to Morganella morganii. J Perinatol Off J Calif Perinatal Assoc 19:533–535
Salen PN, Eppes S (1997) Morganella morganii: a newly reported, rare cause of neonatal sepsis. Acad Emerg Med Off J Soc Acad Emerg Med 4:711–714
Rowen JL, Lopez SM (1998) Morganella morganii early onset sepsis. Pediatr Infect Dis J 17:1176–1177
Wan KS, Liu CK, Chen LH (2007) Primary urinary tract infection in infants: prophylaxis for uncomplicated pyelonephritis. Nephrol (Carlton) 12:178–181
Okike IO, Johnson AP, Henderson KL, Blackburn RM, Muller-Pebody B, Ladhani SN, Anthony M, Ninis N, Heath PT (2014) Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance. Clin Infect Dis Off Publ Infect Dis Soc Am 59:e150–e157
LeBlanc CM, Allen UD, Ventureyra E (1995) Cephalhematomas revisited. When should a diagnostic tap be performed? Clin Pediatr 34:86–89
Sonnen GM, Henry NK (1996) Pediatric bone and joint infections. Diagnosis and antimicrobial management. Pediatr Clin North Am 43:933–947
Kaufman HH, Hochberg J, Anderson RP, Schochet SS Jr., Simmons GM Jr. (1993) Treatment of calcified cephalohematoma. Neurosurgery 32:1037–1039 discussion 1039-1040
Martinez-Lage JF, Esteban JA, Martinez Perez M, Poza M (1984) Craniostenosis secondary to calcified subperiosteal hematoma: case report. Neurosurgery 15:703–704
Wong CH, Foo CL, Seow WT (2006) Calcified cephalohematoma: classification, indications for surgery and techniques. J Craniofac Surg 17:970–979
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
Rights and permissions
About this article
Cite this article
Staudt, M.D., Etarsky, D. & Ranger, A. Infected cephalohematomas and underlying osteomyelitis: a case-based review. Childs Nerv Syst 32, 1363–1369 (2016). https://doi.org/10.1007/s00381-016-3084-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-016-3084-4