import json

references = [
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [1067,1068]},
  {"title": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition", "author": "Tricia Lacy Gomella, Fabien G. Eyal and Fayez Bany-Mohammed", "pages": [104,804]},
  {"title": "Pediatric Board Study Guide", "author": None, "pages": [57]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [34]}
]

short = [{"title": "In short", "content": """- Cephalohematoma is a subperiosteal hemorrhage from ruptured blood vessels traversing the skull to the periosteum, classically confined below the periosteum of a single cranial bone — it never crosses suture lines, which is the key distinguishing feature from caput succedaneum.
- Incidence estimates range from about 0.4–2.5% of live births (commonly cited as roughly 1–2.5%); it is more common in males and with instrumental delivery — about 4–5 times more common with forceps, 8–9 times with vacuum extraction, and 11–12 times with combined forceps-plus-vacuum delivery.
- Overlying skin is intact with no discoloration, petechiae, or hemorrhage; because bleeding is slow, swelling is often delayed, appearing hours to days after birth and becoming more prominent once initial scalp edema (caput) subsides.
- The mass is initially firm, becoming more fluctuant after about 48 hours, with a palpable rim/ridge around the edges that can create a false sensation of central skull depression.
- Most cephalohematomas are unilateral (bilateral is possible) and resolve over about 2–6 weeks (sources cite 2–3 weeks up to several months, or 3–4 weeks depending on size); they may calcify at the edges (often starting by the end of week 2), sometimes leaving a residual bony bump or, rarely, a persistent cystlike diploic defect visible on imaging for months to years.
- An underlying linear (non-depressed) skull fracture is associated with roughly 5–25% of cases (estimates vary by source); imaging (skull x-ray or CT) is not routinely needed and should be reserved for suspected fracture or abnormal neurologic findings.
- Monitor hematocrit/hemoglobin and bilirubin: significant blood loss into the hematoma can occur, and resorption of that blood can worsen neonatal jaundice.
- Rare complications include osteomyelitis of the underlying skull (most often E. coli or Staphylococcus aureus) and, exceptionally, an occipital cephalohematoma being mistaken for an encephalocele (encephalocele transilluminates, is pulsatile, and has an underlying bony defect — ultrasound or CT distinguishes the two).
- Aspiration is rarely necessary and is generally avoided given infection risk; most cases require no treatment beyond monitoring, though phototherapy may be needed if hyperbilirubinemia develops. Subgaleal hemorrhage is a distinct, more dangerous entity (blood between the aponeurosis and periosteum, can extend to the orbits/neck, can hold up to 70% of an infant's blood volume, and may present with coagulopathy if massive) and must not be confused with a simple cephalohematoma."""}]

long = [
 {"title": "Definition", "content": """Cephalohematoma is a subperiosteal hemorrhage — an accumulation of blood between the skull bone and its overlying periosteum — that results from rupture of blood vessels traversing the skull to the periosteum. Because the periosteum is tightly adherent at the suture lines, the hemorrhage is confined to a single cranial bone (most often a parietal bone) and, by definition, never crosses a suture line. This is the key feature distinguishing it from caput succedaneum, a more superficial scalp swelling that does cross suture lines."""},
 {"title": "Epidemiology", "content": """Reported incidence ranges from about 0.4% to 2.5% of live births across sources, with figures of roughly 1–2%, up to 2%, and approximately 2.5% all cited in different references — occurring regardless of mode of delivery, though it is notably more common in males and with instrument-assisted delivery. Compared with spontaneous vaginal delivery, the risk is roughly 4–5 times higher with forceps delivery, 8–9 times higher with vacuum extraction, and 11–12 times higher when forceps and vacuum are used together."""},
 {"title": "Etiology", "content": """The proximate cause is rupture of the small blood vessels (emissary or superficial veins) that cross from the skull to the periosteum, most often from a difficult or instrument-assisted delivery (forceps or vacuum extraction), though traumatic delivery in general can produce it."""},
 {"title": "Clinical features", "content": """The overlying scalp is intact, without discoloration, petechiae, or hemorrhage. Because bleeding beneath the periosteum is slow, the swelling is often not apparent immediately at birth; it typically becomes evident over the following hours to days and often becomes more prominent after the immediate newborn period as coexisting scalp edema (caput succedaneum) subsides. The mass is initially firm and tense, becoming softer and more fluctuant after about 48 hours, with a palpable, well-defined rim or ridge at its margins; this rim can create a false sensation of central depression that may be mistaken for — but does not confirm — an underlying skull fracture or bony defect. Most cases are unilateral, though bilateral cephalohematomas occur. Resolution is slow, typically over 2–6 weeks depending on size (individual sources cite ranges from 2–3 weeks up to several months, or 3–4 weeks), and the lesion may calcify at its edges, sometimes beginning by the end of the second week of life; a minority leave a residual hard bony bump, or, rarely, a persistent cystlike defect in the diploic space visible on imaging for months to years."""},
 {"title": "Diagnostics", "content": """Diagnosis is clinical, based on the characteristic firm-then-fluctuant swelling confined to one cranial bone with a palpable rim and no overlying skin change. Imaging (skull radiograph or CT) is not routinely indicated and should be reserved for cases where an underlying skull fracture is specifically suspected or where abnormal neurologic findings are present; when obtained, an associated fracture is usually linear and non-depressed, found in an estimated 5–25% of cases depending on the series. Laboratory monitoring should include hematocrit or hemoglobin (given the risk of clinically significant blood loss into the hematoma) and serial bilirubin (since resorption of the extravasated blood can precipitate or worsen neonatal jaundice). An occipital cephalohematoma is uncommon and can occasionally be confused with an encephalocele; unlike a cephalohematoma, an encephalocele transilluminates, is pulsatile, and overlies a bony defect, and ultrasound or CT can be used to distinguish between the two when the diagnosis is unclear."""},
 {"title": "Complications", "content": """Cephalohematomas may be associated with intracranial hemorrhage in a minority of cases and with a linear skull fracture in a meaningful proportion (estimates ranging roughly 5–25% depending on the series). A rare but serious complication is osteomyelitis of the underlying skull, most commonly due to Escherichia coli or Staphylococcus aureus. Significant blood loss into a large cephalohematoma can occur and, as the blood resorbs, can worsen neonatal hyperbilirubinemia. Cephalohematoma should be distinguished from the more dangerous subgaleal hemorrhage, a collection of blood between the galea aponeurotica and the periosteum that is usually associated with vacuum-assisted delivery from rupture of emissary veins; subgaleal hemorrhage can appear 1–6 hours after birth, can extend to the orbits and neck, can accommodate up to 70% of the infant's total blood volume, and — if massive — may be accompanied by coagulopathy, making it a substantially more urgent diagnosis to recognize."""}
]

clinical = [
 {"title": "Management", "content": """Most cephalohematomas require no specific treatment and resolve spontaneously over 2–6 weeks with observation alone. Reassure parents proactively that the firm rim and any residual calcified bump are part of the normal resolution process and are a frequent source of unnecessary parental concern. Obtain skull imaging (x-ray or CT) only if there is clinical suspicion of an underlying fracture (e.g., a particularly traumatic or instrumented delivery) or if abnormal neurologic findings are present — imaging is not routine for an uncomplicated cephalohematoma. Check a hematocrit/hemoglobin and monitor bilirubin serially, since a large cephalohematoma can represent a clinically significant blood loss and its resorption can precipitate or exacerbate neonatal jaundice; treat resulting hyperbilirubinemia with phototherapy as indicated using standard criteria.

Avoid aspiration of the hematoma, which is rarely necessary and carries infection risk; if signs of infection (fever, worsening local erythema/warmth, systemic illness) develop, consider osteomyelitis of the skull and cover empirically for E. coli and S. aureus while pursuing further evaluation. Distinguish cephalohematoma promptly from subgaleal hemorrhage at the bedside, since the latter is a hemodynamic emergency: subgaleal hemorrhage crosses suture lines, can extend to the orbits and neck, may develop 1–6 hours after a vacuum-assisted delivery, and can sequester a large fraction of the infant's blood volume — these infants need close monitoring for hypovolemia and coagulopathy rather than the simple observation appropriate for an uncomplicated cephalohematoma. If an occipital cephalohematoma is being considered, confirm it is not an encephalocele (which transilluminates, is pulsatile, and overlies a bony defect) with ultrasound or CT before assuming a benign course."""}
]

article = {
 "topic": "Cephalohematoma",
 "slug": "cephalohematoma",
 "category_id": 15410,
 "summary": "How to recognize a newborn cephalohematoma, distinguish it from caput succedaneum and the more dangerous subgaleal hemorrhage, and manage its expected complications.",
 "written_by": "claude-sonnet",
 "references": references,
 "short": short,
 "long": long,
 "clinical": clinical
}
with open("/tmp/claude-0/-home-danvics-docker-quiz/c1e0577a-e42c-4a3d-b1ea-3edd61103a4e/scratchpad/articles/cephalohematoma.article.json", "w") as f:
    json.dump(article, f, indent=1)
print("done")