Identification and management of neonatal skull fractures

Objective:suspected skull fractures in the neonate are uncommon and present a management dilemma. we hypothesized that skull fractures are more common than reported in the literature and that few infants require any intervention.study design:we retrospectively reviewed the charts of 21 infants referred to our level iv neonatal intensive care unit for possible skull fracture over a 3-year period after birth trauma, suspicious findings on clinical exam, or accidental falls in the birth hospital.results:skull films at the birth hospital were unreliable for fracture in 23% of cases. seven of nine infants with accidental falls had fracture on computed tomography scan. only three infants required neurosurgical intervention, all after severe birth trauma associated with instrumentation.conclusion:skull fractures are more common than previously reported in neonates after accidental falls, but few infants with skull fractures require neurosurgical intervention.