FIGURE 96.25 Subgaleal hematoma Discoloration and swelling extends across suture lines onto the neck, even onto the ear, causing protuberance of the pinna (Reprinted with permission from Fletcher MA Physical Diagnosis in Neonatology Philadelphia, PA: Lippincott–Raven Publishers; 1998:185.) SGH develops insidiously and may not be apparent until several hours or even days after delivery and until blood loss is extensive Discoloration of the scalp occurs very late because blood collects deep beneath the aponeurotic layer Pallor and weakness may be the only early symptoms of SGH and may be accompanied by a rising pulse rate and increasing respiratory rate Diffuse pitting swelling of the scalp or a fluctuating mass extending from the occiput posteriorly to ecchymotic orbits anteriorly and displacing the ears is suggestive ( Fig 96.25 ) Hypoperfusion and falling hematocrit in a child who has undergone a difficult extraction should alert the clinician to the possibility of SGH even in the absence of a fluctuant mass CT scan will demonstrate presence of blood in subgaleal space and rule out associated fractures or intracranial hemorrhages ( Fig 96.26 ) Patients with significant SGH may require emergency-packed RBC transfusion, and fresh frozen plasma if PTT is prolonged Concomitant intravenous administration of vitamin K can be performed Surgical drainage can be considered as a last resort SGH with shock has a high mortality rate of 22% to 25% Facial Nerve Palsy