A newborn skull fracture is a fracture of one or more bones in the head. Newborn skull fractures are rare, but the occurrence is very alarming because trauma that is severe enough to cause a skull fracture is also likely to cause damage to the brain. Additionally, skull fractures can cause damage to the blood vessels and nerves in the head and the inner ears.
Types of Newborn Skull Fractures
There are four main types of newborn skull fractures: linear, depressed, basilar, and diastatic. Linear fractures involve a break in the bone that does not move the bone. Linear newborn skull fractures typically do not require treatment. The baby should be observed carefully and moved very little until the fracture has been allowed ample time to heal.
Depressed Skull Fractures
Depressed skull fractures cause part of the skull to sink into the head. Depressed skull fractures are often accompanied by lacerations to the scalp. Depending on the angle and the severity of the depressed skull fracture, the injury may cause damage to the brain. In many cases, surgery is necessary to set the fractured part of the skull correctly.
Basilar Skull Fractures
Basilar skull fractures are fractures to the bones at the base of the skull. The pressure from this type of fracture often causes bruising around the eyes and behind the ears. In some cases, the covering around the brain may be torn and cause additional complications and symptoms.
Diastatic Skull Fractures
Diastatic skull fractures are common in newborns because of the frailty of the sutures. The sutures are the joints in between the bones of the top of the skull. As children grow and develop, these bones become fused together by Sharpey’s fibres, a type of connective tissue. In newborns, the bones are not fused together and are more susceptible to injury. When the suture bones are fractured or widened, the brain is vulnerable to damage.
Newborn Skull Fracture Causes
Physicians may cause a newborn skull fracture to occur during delivery by practicing improper birthing techniques or incorrectly using tools to assist with difficult deliveries. In some cases, infants may become injured when presentation is abnormal and the skull comes into contact with the mother’s pelvis. Newborns may also be handled incorrectly following birth and an accident may cause a skull fracture.
Skull Fracture Symptoms
The symptoms of a skull fracture in newborns may vary depending on the type of fracture, but may include:
- Abnormal shape to the head
- Lump or swelling of the head
- Fluid or blood coming out of the nose or ears
- Sleeping for longer than is normal
- Lacerations to the head
- Bruising around the eyes or ears
Newborn Skull Fracture Diagnosis
Physicians may use a number of screening tests to diagnose newborn skull fractures. Screening tests may include neurological checks, reflex tests, X-rays, MRIs, CT scans, and nasal CSF tests. Neurological checks may include tests to check the baby’s pupil response to light, memory function, and ability to wake up easily. X-rays, CT scans and MRIs may be used to spot any tissue swelling, broken bones, or injury to the brain tissue or blood vessels. Nasal CSF tests are used to identify clear fluid coming from the nose as either spinal fluid or normal nasal drainage.
Newborn Skull Fracture Treatment
Treatment for newborn skull fractures is determined individually and is based on additional injuries and conditions that may have occurred as well as the fracture. If there is swelling of the brain or other sources of intracranial pressure, the child may need to be monitored using a catheter or surgical bolt inserted into the head that is attached to an electronic monitor until the swelling goes down. There is a very high risk for brain damage when intracranial pressure is present.
Treatment for newborn skull fracture may include:
- Topical antibiotics for lacerations
- Pain medication
- Anti-convulsant medication
- Neck brace to prevent head from moving
- Irrigation and debridement
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