Neonatal period and early infancy Flashcards
Toxic erythema of newborn
This is a self-limiting benign condition
onset usually 24–48 hrs after birth (up to 14 days).
Erythematous macules mainly on face and trunk.
Flea-bitten appearance.
Resolves spont. in a few days.
No treatment required.
Infantile haemangioma (strawberry naevus)
Usually on head and neck.
Starts as a pinpoint red lesion at birth
- grows up to the age of 6–12 mths,
- then slow involution up to 5–10 yrs.
Reassure parents and show how to stop any bleeding.
Worst complication is ulceration (use dressings with Duoderm or Intrasite gel).
Active non-treatment is the rule but:
- beta-blockers have proven effectiveness, e.g. oral propanolol (with caution)
- and topical timolol drops or gel.
Lasers can promote healing but treatment usually unnecessary.
Refer lesions on eyelids and multiple lesions.
Miliaria (‘sweat rash’)
This is related to overheating and appears as two types:
- crystallina—beads of sweat trapped under the forehead, scalp, face and trunk
- rubia or heat rash mainly on forehead, scalp, face and trunk
Appears to be a type of folliculitis due to Pityrosporum orbiculare.
It is a benign condition that disappears after a few wks (usually clears by age of 6 mths).
If problematic:
- keep skin dry and cool (e.g. fan, air conditioner)
- dress in loose–fitting cotton clothing
- reduce activity
- avoid frequent bathing and overuse of soap
Rx: salicylic acid 2%, menthol 1%, chlorhexidine 0.5% in alcohol
Prevention: Ego Prickly Heat Powder
Frey’s syndrome
The child develops a red superficial rash or discolouration on the face (upper cheeks) on eating or drinking.
It is presumed to be related to auriculo-temporal nerve damage due to forceps delivery.
Usually improves with age.
Transient neonatal pustular dermatosis
This is a blistering eruption with pustules presenting at birth or in the first few hours of life.
Occurs mainly on the trunk and buttocks.
No treatment required.
Naevus flammeus (salmon patch)
Dilated capillaries form on;
- face and eyelids (~50% of babies)
- nape of neck or
- between eyelids ‘Angel’s Kiss’.
Fades over 6–12 mths
- but neck patches may persist into adult life.
No treatment required.
Capillary malformation (port wine stain)
Present from birth
- —surgery inadvisable.
Assessment for underlying vascular abnormalities advised if
- the lesion is in the area supplied by the ophthalmic or maxillary divisions of the trigeminal nerve.
Consider the Sturge–Weber syndrome:
- —associated intellectual disability and epilepsy.
The stains can be considered for pulsed dye laser therapy
- probably best in first 2 yrs or
- when the colour changes to bluish-red, usually in early adulthood.
Cosmetic camouflage useful.
Sebaceous hyperplasia
Hyperplastic sebaceous glands
- appear as tiny yellow-white papules on the nose at birth, esp. at the tip.
Disappear in several wks.
Naevus sebaceous
This is a variation of sebaceous hyperplasia
usually found on the head or neck as a yellow-orange coloured
- circumscribed or
- linear lesion.
Leave it to resolve.
Congenital naevi
These have to be treated on an individual basis.
If giant naevi, they can be dermabraded at ideally <6 wks.
Benign juvenile melanoma
Brown pigmented lesions on face
usually surgically excised because of rapid growth and family concerns.
Milia
Blocked sebaceous glands, esp. on the face,
- present in 50% of neonates.
The firm white papules are ~1–2 mm in diameter
- differ from the yellowish papules of sebaceous hyperplasia.
Also disappear after several weeks.
Sucking blisters
These are common on upper lip.
Reassure these will settle.
Umbilical granuloma
Gently apply a caustic pencil daily for ~5 d.
Alternatives include a silver nitrate stick and copper sulphate crystals.
Breast hyperplasia
A breast ‘bud’ is common in most term babies
- may enlarge with breastfeeding.
Milk may discharge from some (‘witches’ milk’)
- but reassurance is all that is required.
