Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations.

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.