FIGURE 96.18 Neonatal herpes simplex Herpetic vesicles and erythema at the site of scalp electrode placement (Courtesy of Shirley P Klein In: Chung EK, Atkinson-McEvoy LR, Boom JA, et al., eds Visual Diagnosis and Treatment in Pediatrics 2nd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2010 With permission.) Symmetry Molding of the skull bones during the vaginal delivery process is a common cause of temporary asymmetry, as is scalp edema or caput succedaneum ( Fig 96.16 ) Caput succedaneum is an ill-defined, generalized swelling of the soft tissues of the scalp that was the presenting part during a vertex delivery It is composed of edematous skin containing extravasated serum or blood that extends across suture lines Presence of localized petechiae and purpura can occur Generally, both caput succedaneum and skull molding spontaneously resolve by to 10 days of age Overriding cranial sutures, or molding, that persists beyond to 10 days may be a sign of underlying brain pathology and deserve further evaluation Ridging or prominence of cranial sutures may be a sign of craniosynostosis, a premature fusion of cranial sutures Overriding sutures are ballottable, but if the sutures are rigid and have a heaped-up solid closure, radiographs, or CT scan should be conducted to rule out craniosynostosis Soft areas, craniotabes, are occasionally found on palpation of the parietal bones during the first several days of life, especially in premature infants Soft areas noted in the occipital region may be suggestive of osteogenesis imperfecta or other syndromes and should be investigated