Pediatric emergency medicine trisk 2493 2493
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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 7
to 10 days of age.
Overriding cranial sutures, or molding, that persists beyond 7 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.
