One page summary: Intracranial hemorrhage in newborns: subdural, subarachnoid, epidural and subgaleal

In two sentences

Bleeding around a newborn's brain is described by which layer it sits in. Subdural, subarachnoid and epidural bleeds are inside the skull. Subgaleal bleeding is outside the skull, under the scalp, and it is the dangerous one. ¹

If you were told your baby has a subgaleal hemorrhage, that is a medical emergency because a newborn can lose a large share of their total blood volume into that space within hours. If you were told subdural or subarachnoid, those are more common, usually smaller, and most babies recover fully. ¹

The numbers, with their sources

• The one that is an emergency. Subgaleal hemorrhage. The space under the scalp can hold a very large volume of blood, and a newborn can bleed into it fast enough to go into shock ¹
• The most common. Small subdural and subarachnoid bleeds are found often on scans of newborns, including babies who look completely well ¹
• The main link to instruments. Subgaleal hemorrhage is most associated with vacuum-assisted delivery, which is why guidance sets limits on how vacuum is used ²
• How it is found. CT is fast and good at fresh blood. MRI shows more detail and avoids radiation. Subgaleal bleeding is diagnosed by examining the head and by serial measurement, not by waiting for a scan ¹
• The bedside sign that matters most. A boggy, swelling scalp that crosses the suture lines and shifts when the head is moved, together with a rising heart rate and a falling blood count ¹

What to do this week

1. Ask which kind of bleed it is, in exact words, and ask for the imaging report.
2. If it was subgaleal, ask what time it was recognized, what the head circumference measurements were, and what the blood count did.
3. If an instrument was used, ask which one, how many pulls, and whether the cup came off. All of this is recorded in the operative note.
4. Ask whether bilirubin is being followed, since a large collection can push it up days later.
5. Ask whether head circumference is being tracked for hydrocephalus.
6. Request the complete records using the records request builder.
7. Ask for developmental follow-up to be arranged before discharge.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist

• Exactly which kind of bleed is this, and how large?
• Was there a period of low blood pressure or low oxygen?
• What were the head circumference measurements, and at what times?
• What did the blood count do over the first 24 hours?
• Is bilirubin being followed as the blood breaks down?

For the obstetric team

• Was an instrument used, and which one?
• How many attempts, and did the vacuum cup detach at any point?
• What was the indication for the assisted delivery?
• Is all of that in the operative note?

For the neurologist or neurosurgeon

• Does this bleed need any intervention, or watching?
• What are we watching head circumference for?
• Is there a seizure risk?
• What follow-up do you want, and when?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Intracranial hemorrhage in newborns: subdural, subarachnoid, epidural and subgaleal

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.