Scalp Swelling, a Proxy for "Birth Trauma," Is Not Associated With Neonatal Brain Injury

The issue of so called "birth trauma"and its potential association with neonatal brain injury is incompletely explored in the literature but of interest to parents, obstetricians, pediatricians, neonatologists, child neurologists, and lawyers. The study presented by Dunbar et al.1 in this issue of Neurology® provides a method to address the potential relationship or causal association of external forces on the neonatal head during the birth process, so called "birth trauma,"with the development of neonatal brain injury. This is an important study because currently there is no rigorous evidence using quantitative measures in the literature that substantially addresses this question. In the rare cases in which a newborn develops signs of brain injury shortly after birth, there may be parental distress and psychological trauma around the birthing process that can be further amplified by a difficult delivery and/or the presence of significant molding and caput succedaneum (scalp swelling). Birthing persons, parents, and family members may incorrectly conclude that the same mechanisms that lead to the development of scalp swelling equate to "birth trauma,"and may increase the risk of or directly cause brain injury.