NR 602 Common Neonatal Conditions

NR 602 Common Neonatal Conditions

NR 602 Common Neonatal Conditions

Common Neonatal Conditions

Skin Conditions

Table 39-3 lists newborn skin disorders.

TABLE 39-3

Comparison of Newborn Skin Disorders

Rash	Significant Maternal or Infant History	Rash Description	Diagnostics	Management/Treatment
Milia	None	Firm, pearly, white papules over cheeks, nose, and forehead	None	Superficial inclusion cysts will spontaneously resolve
Sebaceous hyperplasia	None	Prominent, yellow-white papules over cheeks, nose, and forehead	None	Overgrowth of sebaceous glands will spontaneously resolve in first few weeks
Erythema toxicum	None Presents at 24 to 48 hours	Yellow-white papules with an erythematous base over cheeks, nose, and forehead	Wright stain demonstrates large number of eosinophils Cultures are sterile	Clears within 2 weeks, completely gone in 4 months
Transient neonatal pustular melanosis	None More common in darker skinned persons	Vesicopustules that rupture easily and leave a halo of white scales around a central macule of hyperpigmentation on trunk, limbs, palms, and soles	None	Spontaneous resolution in 2 to 3 days although hyperpigmentation can persist for up to 3 months
Sucking blisters	Results from vigorous sucking in utero on the affected part	Scattered superficial bullae on the upper arms and lips of infants at birth	None	Will resolve without additional intervention
Cutis marmorata	Accentuated physiologic response to cold	Lacy, reticulated, red or blue vascular pattern	None	Transient and will resolve with warming
Harlequin color change	None	Half of the baby’s coloring is red and the other pale	None	Transient and will resolve
Nevus sebaceous	None	Yellow, hairless smooth plaque on head or neck	None	Total excision prior to adolescence; refer to dermatologist
Herpes simplex virus (HSV)	Mother may have active lesions or a history of disease	Grouped vesicles on erythematous base	DFA or ELISA detection of HSV antigens	Acyclovir

DFA, Direct fluorescent antibody; ELISA, enzyme-linked immunosorbent assay.

 

Milia

Milia are multiple, firm, pearly, opalescent white …

Sebaceous Hyperplasia

Sebaceous hyperplasia is characterized by prominent yellow-white papules …

 

NR 602 Common Neonatal Conditions

Impetigo

Impetigo is a common contagious bacterial infection of the superficial layers of the skin. It has two forms: …

FIGURE 37-4 A, Nonbullous impetigo. B, Bullous impetigo. (From Bologia J, Schaffer JV, Duncan KO, et?al: Dermatology essentials, Philadelphia, 2014, Saunders/Elsevier.)

 

Clinical Findings

History

• Pruritus, spread of the lesion to surrounding skin, and earlier skin disruption at the site
• Weakness, fever, and diarrhea may accompany bullous impetigo

NR 602 Common Neonatal Conditions

Physical Examination

The following can be found:

• Nonbullous, classic, or common impetigo—begins as 1- to 2-mm erythematous papules or pustules that pro­gress to vesicles or bullae, which rupture, leaving moist, honey-colored, crusty lesions on mildly erythematous, eroded skin; less than 2?cm in size; little pain but rapid spread
• Bullous impetigo—large, flaccid, thin-wall, superficial, annular, or oval pustular blisters or bullae that rupture, leaving thin varnish-like coating or scale

• Lesions are most common on face, hands, neck, extremities, or perineum; satellite lesions may be found near the primary site, although they can be anywhere on the body
• Regional lymphadenopathy …

NR 602 Common Neonatal Conditions

Diagnostic Studies

Gram stain and …

Differential Diagnosis

Herpes simplex, …

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Management

Management involves the following:

• Topical antibiotics may be used if the impetigo is superficial, …
• Cephalexin: …
• Amoxicillin/clavulanate: …
• Dicloxacillin: …
• Cloxacillin: …
• Clindamycin: …
• For widespread infection with constitutional symptoms and deeper skin involvement, use an oral antibiotic active against beta-lactamase–producing strains of S. aureus, such as …
• If an infant has bullous impetigo, use …
• If there is no response in 7 days, swab beneath the crust, and do Gram stain, culture, and sensitivities. Community-acquired MRSA should be considered. This organism is more susceptible to clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) (see Chapter 24 for treatment of MRSA).
• Educate regarding cleanliness, hand washing, and spread of disease.
• Exclude from day care or school until treated for 24 hours.
• Schedule a follow-up appointment in 48 to 72 hours if not improved.

Complications

• Cellulitis may occur with nonbullous impetigo and …
• Lymphangitis, suppurative lymphadenitis, guttate psoriasis, …
• Staphylococcal scalded skin syndrome (SSSS) is a blistering disease that …

Patient and Family Education

• Thorough cleansing of any breaks in the skin helps prevent impetigo.
• Postinflammatory pigment changes can last weeks to months.
• The patient should not return to school or day care until 24 hours of antibiotic treatment is completed.