Journal List > Korean J Perinatol > v.27(2) > 1013789

Korean J Perinatol. 2016 Jun;27(2):103-109. Korean.
Published online June 30, 2016.
Copyright © 2016 The Korean Society of Perinatology
Clinical Significance of Epidural Hematoma Related to Birth in Newborn
Dong Jun Lee, M.D., Yeon Kyung Lee, M.D., Sun Young Ko, M.D., Son Moon Shin, M.D. and Byoung Hee Han, M.D.1
Department of Pediatrics, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea.
1Department of Diagnostic Radiology, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea.

Correspondence to: Yeon Kyung Lee, M.D. Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, 17, Seoae ro 1 Gil, Jung-gu, Seoul 04619, Korea. Tel: +82-2-2000-7771, Fax: +82-2-2000-7778, Email:
Received February 06, 2016; Revised April 09, 2016; Accepted April 11, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Epidural hematoma (EDH) in newborn is very rare, but when it occurs it is usually due to birth injury. We have evaluated the incidence and clinical features of EDH related to birth in newborn.


We analyzed medical records of 12 newborns diagnosed with EDH at Cheil General Hospital and Women's Health Care Center from January 2000 to December 2015 retrospectively.


The incidence of EDH related to birth was 0.01%, occurring in 1 of 10,000 live births. Of the total 12 cases, 10 occurred in male and 8 in vaginal delivery. Among them, 11 infants had evidences of birth injury. Clinical presentation was nonspecific: only 1 infant had neurologic symptoms. The temporooccipital area was the most frequent location of EDH. The median size of EDH was 3.2±0.8 cm in length and 1.2±0.7 cm in depth. Mass effect accompanied with midline shift on radiologic imaging was shown in one case. Surgical drainage was needed only in one infant with neurologic symptom and mass effect on radiologic imaging, while the others were treated conservatively.


Neonatal EDH related to birth was treated conservatively in most cases. The radiologic mass effect and neurologic symptom should be considered as indication for surgical intervention.

Keywords: Epidural hematoma; Newborn


Fig. 1
CT scans of case 10. Before (A) and after (B) surgical treatment. The EDH(arrow), shown as a lentiform high-density area on the left temporal region with mass effect(arrowhead), disappeared after surgery.
Click for larger imageDownload as PowerPoint slide

Fig. 2
CT scans of case 12. (A) Right parietal EDH (white arrow) without mass effect was shown on day 3. (B) After 2 days, follow-up image was obtained and it showed spontaneously decreased amount of EDH (black arrow) on the same region.
Click for larger imageDownload as PowerPoint slide


Table 1
Summary of Clinical Characteristics and Radiologic Findings of EDH
Click for larger imageClick for full tableDownload as Excel file

1. Takagi T, Nagai R, Wakabayashi S, Mizawa I, Hayashi K. Extradural hemorrhage in the newborn as a result of birth trauma. Childs Brain 1978;4:306–318.
2. Noetzel MJ. Perinatal trauma and cerebral palsy. Clin Perinatol 2006;33:355–366.
3. Akiyama Y, Moritake K, Maruyama N, Takamura M, Yamasaki T. Acute epidural hematoma related to cesarean section in a neonate with Chiari II malformation. Childs Nerv Syst 2001;17:290–293.
4. Negishi H, Lee Y, Itoh K, Suzuki J, Nishino M, Takada S, et al. Nonsurgical management of epidural hematoma in neonates. Pediatr Neurol 1989;5:253.
5. Halmat A, Heckly A, Adn M, Poulain P. Pathophysiology of intracranial epidural haematoma following birth. Med Hypotheses 2006;66:371–374.
6. Aoki N. Epidural hematoma communicating with cephalhematoma in a neonate. Neurosurgery 1983;13:55.
7. Aoki N. Epidural haematoma in the newborn infants: therapeutic consequences from the correlation between haematoma content and computed tomography features. A review. Acta Neurochir (Wien) 1990;106:65–67.
8. Kroon E, Bok LA, Halbertsma F. Spontaneous perinatal epidural haemorrhage in a newborn. BMJ Case Rep 2012;2012:pii. bcr0920114735.
9. Heyman R, Heckly A, Magagi J, Pladys P, Hamlat A. Intracranial epidural hematoma in newborn infants: clinical study of 15 cases. Neurosurgery 2005;57:924–929.
10. Yamamoto T, Enomoto T, Nose T. Epidural hematoma associated with cephalohematoma in a neonate-case report. Neurol Med Chir (Tokyo) 1995;35:749–752.
11. Vinchon M, Pierrat V, Tchofo PJ, Soto-Ares G, Dhellemmes P. Traumatic intracranial hemorrhage in newborns. Childs Nerv Syst 2005;21:1042–1048.
12. Park SM, Oh KW, Kim HM. Correlation between cephalhematomas and intracranial hematomas. J Korean Soc Neonatol 2008;15:160–165.
13. Ciurea AV, Kapsalaki EZ, Coman TC, Roberts JL, Robinson JS 3rd, Tascu A, et al. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst 2007;23:335–341.
14. Hymel KP. Traumatic intracranial injuries can be clinically silent. J Pediatr 2004;144:701–702.
15. Mallet EC, Boumahni B. Neonatal extradural hematoma. Arch Pediatr 1996;3:608–609.
16. Mack LA, Wright K, Hirsch JH, Alvord EC, Guthrie RD, Shuman WP, et al. Intracranial hemorrhage in premature infants: accuracy of sonographic evaluation. AJR Am J Roentgenol 1981;137:245–250.
17. Bejar R, Curbelo V, Coen RW, Leopold G, James H, Gluck L. Diagnosis and follow-up of intraventricular and intracerebral hemorrhages by ultrasound studies of infant's brain through the fontanelles and sutures. Pediatrics 1980;66:661–673.
18. Babcock DS, Han BK, Weiss RG, Ryckman FC. Brain abnormalities in infants on extracorporeal membrane oxygenation: sonographic and CT findings. AJR Am J Roentgenol 1989;153:571–576.
19. Adcock LM, Moore PJ, Schlesinger AE, Armstrong DL. Correlation of ultrasound with post mortem neuropathologic studies in neonates. Pediatr Neurol 1998;19:263–271.
20. Pang D, Horton JA, Herron JM, Wilberger JE Jr, Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg 1983;59:958–971.
21. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery 1986;18:696–700.
22. Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, et al. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery 1993;32:176–179.
23. Govaert P. Clinics in developmental medicine. In: Govaert P, Linda S, editors. Cranial haemorrhage in the term newborn infant. Epidural haematoma (cephalhematoma internum, internal subperiosteal bleeding). 1st ed. Cambridge: Mac Keith Press; 1994. pp. 34-40.
24. Ahn DH, Eom KS, Kim DW, Park JT, Moon SK, Kang SD, et al. Traumatic acute epidural hematoma in children. J Korean Neurotraumatol Soc 2009;5:11–15.
25. Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G. Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases. J Neurosurg 1985;62:861–864.