日本新生児成育医学会雑誌　36(2)：115-120；2024　

日本新生児成育医学会雑誌　第36巻　第2号　115 ～ 120頁（2024年）

受付日：2023．03．30

受理日：2024．02．22

頭蓋癆に急性硬膜外血腫を合併した正期産児の1 例

Acute Epidural Hematoma Complicated with Neonatal Craniotabes in a Full-term Infant

国立病院機構仙台医療センター　小児科

National Hospital Organization Sendai Medical Center, Pediatrics

頓所滉平・千葉洋夫・渡邉浩司・星菜美子・齋藤　大・大友江未里・酒井秀行・上村美季・渡邊庸平・大沼良一・久間木　悟

Kohei TONSHO，Hiroo CHIBA，Hiroshi WATANABE，Namiko HOSHI，Dai SAITO，Emiri OTOMO， Hideyuki SAKAI，Miki KAMIMURA，Yohei WATANABE，Ryoichi ONUMA，Satoru KUMAKI

Key Words：craniotabes，acute epidural hematoma，vitamin D deficiency

症例は在胎40 週5 日，出生体重3,018g の男児。分娩経過中に頻回の胎児徐脈を認め緊急帝王切開で出生し，Apgar スコアは1 分7 点，5 分9 点であった。日齢1，大泉門と矢状縫合の離開，左頭頂部に頭血腫を認め，頭血腫直下を 含む頭頂骨が菲薄であった。日齢5 に大泉門の膨隆を認め入院し，頭部CT で両側頭頂骨の頭蓋癆，頭蓋内に急性 硬膜外血腫，その前縁付近に頭頂骨骨折を認めた。通常，急性硬膜外血腫の多くは分娩外傷が原因となる。本症例 では分娩進行に伴い頭部が骨盤腔に陥入し，菲薄な頭頂骨の損傷から急性硬膜外血腫を来したと推察された。患児 の25（OH）ビタミンD は7.2ng/mL と低値で，妊娠中のビタミンD 摂取不足や過度の紫外線対策などから胎内で ビタミンD 不足を来し頭蓋癆を発症したと考えられた。頭蓋癆に急性硬膜外血腫を合併した本邦で初めての症例報 告である。

The patient was a male born at 40 weeks and 5 days of gestation with a birth weight of 3,018 g. He was born by emergency cesarean section due to frequent fetal deceleration during the progression of delivery, and his Apgar score was 7 at 1 min and 9 at 5 min after birth. On day 1, we found wide anterior fontanel, wide interparietal suture, and cephalohematoma. Moreover, we detected craniotabes as softening or thinning of parietal bones in spots including just below the cephalohematoma. On day 5, he was admitted to our neonatal intensive care unit because of a bulging anterior fontanel, and head computed tomography showed craniotabes, acute epidural hematoma, and parietal bone fracture near the anterior margin of the hematoma. Without seizure or any other neurological problems, we had given him an inactive vitamin D supplement against vitamin D deficiency with 7.2 ng/mL of 25（ OH） vitamin D value for 5 months, and his vitamin D deficiency improved. Growth and development were favorable, without any fractures or evidence of rickets by the age of 1 year. Acute epidural hematoma can result from birth injury. In this case, we considered that acute epidural hematoma resulted from a fracture of thin parietal bone accompanied by vitamin D deficiency. Due to vitamin D deficiency in pregnant women with excessive protection from ultraviolet rays, neonatal craniotabes occurs in 20 to 30％ of term infants. We were able to detect an acute epidural hematoma after finding a bulging anterior fontanel. When craniotabes with cephalohematoma is detected, abnormal neurological findings should be noted. This is the first case report of acute epidural hematoma complicated with neonatal craniotabes in a term infant in Japan.