Shape, size, and symmetry are factors that must all be considered in the evaluation of the neonate’s head Macrocephaly, microcephaly, cranial asymmetry, and bulging anterior fontanelle are signs of underlying pathology Goals of Treatment Clinicians need to identify generally innocent etiologies from those that are life threatening The primary goals should be early recognition of hemorrhagic shock from intracranial bleeding and increased intracranial pressure All neonates with disorders of size and shape of head need a thorough physical examination including neurologic examination Those with significant findings will require head US, computed tomography (CT), or magnetic resonance imaging (MRI) In any patient with significant findings, neonatology, neurology, and/or neurosurgery consultation are warranted Admission to the intensive care unit is necessary in infants with cardiovascular instability Clinical Considerations Clinical Recognition The size, shape, and skin discoloration on the head can first be noted by the clinician on inspection of the baby during physical examination Parents are often unaware of the problem unless the head size is severely enlarged, has prominent skin changes, prominent asymmetry, or the baby is presenting with other symptoms Vague symptoms may be noted by the parent including poor feeding, irritability, cyanotic episodes (apneic episodes), fever, inability to maintain temperature, or the baby is “just not herself.” Measurement of the head circumference should be routinely performed for infants presenting within the first weeks of life Triage Considerations Neonates with bulging or sunken fontanelle associated with poor feeding, irritability, or temperature instability should be evaluated promptly for meningitis, sepsis, or shock Associated hypothermia and ill appearance imply neonatal sepsis and demands emergent treatment Clinical Assessment Neonatal disorders of head shape, size, and symmetry are detected by inspection, palpation, and measurement of head circumference The head should be examined in the midline position, then on each side Benign dermatologic lesions such as seborrheic dermatitis (cradle cap) ( Fig 96.15 ), capillary hemangioma, vesicles and ulcers from fetal scalp monitoring electrodes, caput succedaneum ( Fig 96.16 ), cephalohematoma ( Fig 96.17 ) and significant conditions such as giant congenital nevi, port-wine stain, and tumors may be