Common Newborn Conditions

Cutis Marmorata:

• Normal phenomenon, mottled skin appearance
• Vascular response to sudden cold -> affects the entire body (if it’s benign)
• Resolves by warming the baby, if persists -> might be sepsis\infection

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Erythema Toxicum:

• “Well-baby rash”
• Appears on day 3, disappears on day 7
• Maculopapular rash, erythematous base
• Affects trunk, not soles of the feet
• If smear is taken -> shows eosinophils (allergic response)
• Normal phenomenon, not infectious, reassure parents

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Transient Neonatal Pustular Melanosis: 

• Appears as early as first day, disappears after 1 month
• Maculopapular rash, no erythematous base, some pustules
• Involves soles of the feet
• Easily ruptures, heals with pigmentation and crusting

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Acne Neonatorum: 

• Acne in a newborn, same pathology as adult acne; obstructed comadone
• Due to maternal hormones
• Transient, resolves by itself in few weeks

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Milia:

• Retained keratin in the ducts of the premature skin
• Pearly-white pustules -> on the nose, chin, or any area in the face (sometimes persists around the eyes in certain populations)
• Normal, nothing to worry about

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Miliaria: 

• Retained sweat in the ducts of the premature skin
• Miliaria Crystallina: clear white superficial pinpoint vesicles without inflammation
• Miliaria Rubra “heat rash”: obstruction at a deeper level, leads to inflammation, erythematous papules and vesicles

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Seborrheic Dermatitis: 

• “Cradle cap”
• Appears in the 1^st month, disappears by 4^th\6^th month
• Greasy, thick, yellowish lesion -> classically on the scalp, maybe be over the nape of the neck, behind ears
• Advise parents to wash and clean it regularly
• Self-limited, no Tx is needed, but sometimes steroids or topical Tx maybe used

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Ecchymotic Rash: 

• Ecchymotic rash in a newborn is pathological -> TORCH infections, maternal\neonatal varicella, hematological

Congenital self-healing Langerhans cell histiocytosis (CSHLCL):

• Multiple reddish-brownish papulonodules
• Lowe-density microscopy: eosinophils, multinucleated giant cells
• Electron microscopy: Birbeck granules
• + staining for S-100 protein and membranous staining for CD1a antigen

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Collodion Baby: 

• “Ichthyosis”
• Dry, waxy, tight skin around the eyes and joints
• O-shaped mouth
• Classically; this layer will peel off by 7-10 days, and underlying normal skin will show
• Can be hereditary (AR)
• Management:
  • The main aim is to keep skin + baby hydrated, bc the skin is dry and cracked -> prone to infection
  • Admission, hydration, emulsifying ointment, prophylactic abx
  • Life-long emollients -> might lead to deformities if non-compliant

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Dermal Melanosis “Mongolian Spot”:

• Failure of migration of nerve endings -> usually in the lumbosacral area
• Usually disappears in 1^st year, so reassure parents
• If in suspicious area -> suspect non-accidental injuries and abuse -> so ask the mother if it was there at birth or appeared after
• Rule out Nevus of Ota -> will persist and needs to be Tx by laser

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Hemangioma: 

• Natural history of a single hemangioma: increase in size over few months, then gradually fades and change in color (pink\grey\yellowish)
• Tell the pt not to play w\ it, comb hair gently -> so it won’t be injured -> bleeds\gets infected
• When to treat?
  • If beard distribution -> R\O upper airway hemangioma which might obstruct airway
  • Blocking the eyes and keeps them shut
  • Multiple over the body -> R\O visceral hemangioma (liver, spleen)

• How to treat?
  • B-blockers or vincristine to shrink

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Nevus Simplex “Salmon Patch”: 

• Dilatation of dermal capillaries, benign condition
• Classically, medially over the eyes -> “angle’s kiss” -> disappears with time
• Or might be a salmon patch, over the nape of the neck -> persists, but gets covered w\ hair

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Nevus Flammeus “Port-Wine Stain”: 

• Malformation of the superficial capillaries of the skin
• Homogenous, non-raised, erythema over certain parts of the face (classically the cheeks)
• Treated by laser
• Need to rule out Sturge-Weber Syndrome -> distribution over the first branch of the trigeminal nerve, developmental delay and seizures

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Sacral Dimple:

• A spectrum; meningiomyelocele -> meningocele -> spina bifida occulta (intact skin w\out sac)
• The base of the dimple is not visible
• The skin might be normal, or w\ skin tag, tuft or hair, lipoma -> screen for spina bifida; as the baby grows, the cord becomes more tethered -> discover as soon as possible to prevent injury

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Cephalohematoma: 

• Subperiosteal bleeding, confined to one skull plate, doesn’t cross suture line (bc periosteum is stiff and keeps bleeding from expanding)
• Might be due to prolonged labor and compression of the baby’s head against the mother’s pelvis
• Classically; hardens and calcifies -> then resolves spontaneously (few weeks)

 

Caput:

• Only edema and induration of the scalp, crosses suture lines
• Might be due to prolonged labor

 

Subgaleal Hemorrhage: 

• Between scalp and periosteum; a potential space -> can’t tamponade itself and the baby will cont to bleed -> might go into hemorrhagic shock
• “Baggy-like”
• If severe enough, extending down the neck and elevates earlobes -> admit and observe hemodynamics

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Infants of Diabetic Mothers: 

• Gestational DM -> biochemical imbalances: LGA (hyperinsulinemia), hypoglycemia, plethoric (polycythemia), hypocalcemia, hyperbilirubinemia
• Known DM type 1\2 -> congenital anomalies and birth defects: sacral agenesis, left hypoplastic colon, cardiomyopathy (septal hypertrophy)
• Why are birth defects not seen w\ gestational DM? Bc gestational DM develops in the second trimester, where the embryonic phase is over. While in type 1\2 DM, hyperglycemia is there from the beginning during embryogenesis
• RDS occurs not bc surfactant is deficient, but its non-functional due to insulin (transient)

 

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Pulmonary Interstitial Emphysema: 

• Air leak syndrome in the premature, where the lungs are exposed to high pressure ventilation -> rupture of the alveoli -> air will leak into the interstitium -> cystic-like lesions
• Might be followed by pneumothorax

 

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Congenital Diaphragmatic Hernia: 

• Incomplete formation of diaphragm -> defect -> abdominal organs herniate
• Can lead to pulmonary hypoplasia + pulmonary HTN

Types:

• Bochdalek: posterolateral (most common, L>R)
• Morgagni: anterior parasternal

Presentation:

• Respiratory distress
• Scaphoid abdomen

Diagnosis:

• Prenatal US and polyhydramnios
• CXR: bowel gas pattern in hemithorax + mediastinal shift

Treatment:

• ET + NGT
• If stable -> surgical repair: hernia reduction \ patch
• If unstable -> NO +\- ECMO -> then surgery

 

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Esophageal Atresia With Tracheo-esophageal Fistula:

• Failure of complete separation of trachea from esophagus

Types:

1. Esophageal atresia w\out TEF
2. Proximal esophageal atresia w\ proximal TEF
3. Proximal esophageal atresia w\ distal TEF (most common)
4. Proximal esophageal atresia w\ proximal + distal TEF
5. “H-type” TEF w\out esophageal atresia

Presentation:

• Postnatal:
  • Excessive salivary secretions
  • Respiratory distress\chocking\regurgitation after first feeding
• Prenatal:
  • Preterm
  • Polyhydramnios

Diagnosis:

• AXR + NGT: coiled NGT in upper esophagus
• Gas in stomach = w\ TEF. No gas in stomach = w\out TEF

Treatment:

• Suction blind pouch (NPO\TPN)
• Prophylactic abx (amp\gent)
• Surgical repair; thoracotomy:
  • Ligation of TEF
  • Anastomosis of 2 ends of esophagus

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Necrotizing Enterocolitis: 

• Transmural intestinal necrosis
• Premature gut gets exposed to feeding that’s not tolerated sometimes

Presentation:

• Bloody stool, apnea, lethargy
• If perforation -> abdominal distension

Diagnosis: 

 

• Pneumatosis intestinale on plain film

Treatment:

• Cessation of feeds, NGT, Abx, IVF
• Surgical resection of necrotic bowel

 

 

 

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Download the PDF version: here

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References:

• Dr Alsaleem and Dr Alnamshan’s lectures
• First aid for the surgery clerkship
• Monte Reid