Diagnostic evaluation of neonates with suspected head injury at birth

CT: computed tomography; MRI: magnetic resonance imaging; US: ultrasound.

* Suspicion for head injury is based on physical findings suggestive of significant head injury or risk factors such as forceps/vacuum assisted delivery, or prolonged head engagement during delivery.

¶ MRI can be useful for nonurgent diagnosis but may require sedation of the neonate for optimal results. If an experienced operator is available, cranial US is a useful diagnostic tool for suspected SGH and is preferable to CT due to lack of ionizing radiation. However, the approach to diagnosis of SGH and choice of imaging modality may vary by institution.

Δ If an experienced operator is available, US is an alternative. If radiographs or US are suggestive of depressed skull fracture, we obtain CT or MRI to evaluate for ICH, particularly if the fracture depth exceeds 1 cm. MRI can be useful for nonurgent diagnosis however may require sedation of the newborn for optimal results.

◊ Caput succedaneum and cephalohematoma typically self resolve and do not require diagnostic imaging. Imaging may be needed to rule out other types of head injury or if other complications arise.