Neonatal epidural hematoma following non-instrumental birth trauma: case report and literature review

Abstract Neonatal epidural hematoma (EDH) is an extremely rare but potentially life-threatening complication of birth trauma. Although instrumental delivery is a well-known risk factor, EDH may also occur after non-instrumental spontaneous vaginal delivery. Early recognition and prompt management are essential to prevent serious neurological consequences. Case report A 9-hour-old male neonate born at 36 weeks by spontaneous non-instrumental vaginal delivery after difficult labor developed a left parietotemporal cephalohematoma. Cranial computed tomography (CT) was preferred because it rapidly detects acute hemorrhage and skull fractures in neonates with suspected intracranial injury. CT demonstrated a displaced skull fracture with an underlying epidural hematoma measuring 3.5 × 1 cm. Approximately 35–40 cc of hematoma was surgically evacuated, and the displaced bone was remodelled. The postoperative course was uneventful without neurological deficits. Conclusion Neonatal EDH can occur even without instrumental delivery. Prompt CT imaging and early surgical management provide excellent outcomes. Careful evaluation is warranted in neonates following difficult or prolonged labor.