Table of Contents

2017 Month : December Volume : 6 Issue : 93 Page : 6695-6702

SKIN CHANGES IN NEONATES DURING EARLY NEONATAL PERIOD.

Parag Sharma1, Abhiram Behera2

1Associate Professor, Department of Dermatology and Venereology, Terna Medical College, Nerul, Navi Mumbai.
2Statistician cum Lecturer, Department of Community Medicine, Terna Medical College, Nerul, Navi Mumbai.

Corresponding Author:
Dr. Parag Sharma,
Flat No. 305, Dharti Complex,
Plot 60/61, Sector-18,
Kamothe, Navi Mumbai-410209.
E-mail: paragsharma8@rediffmail.com

ABSTRACT

backgrounD

The early neonatal period is considered to be the first 7 days of life after birth. The skin undergoes a variety of changes during this period, which reflects the neonates’ functional adaptability to its new environment. These changes resolve spontaneously within a few weeks and are regarded as physiological. Skin changes other than physiological are called pathological. These pathological changes are either transmitted from the parents or acquired from the external environment.

The objective of this study is to determine the relative incidence of physiological and pathological skin changes, their relation to maternal and neonatal factors and the time of their appearance and disappearance in this part of the world.

MATERIALS AND METHODS

1000 live-born babies delivered in labour room over a period of 1 year and who could remain in the hospital for at least 7 days were selected for the present study. Babies were followed up daily till the next 7 days.

RESULTS

1000 neonates developed 6905 skin changes during their early neonatal period at an average of 6.9 lesions per neonate. Only 2 of them required immediate intervention. There were 5820 (84.3%) physiological skin changes and 1085 (15.7%) pathological skin changes. Pathological skin changes include 366 (5.3%) infectious, 514 (7.4%) non-infectious and 205 (3%) developmental defects. Amongst physiological skin changes, physiological desquamation of skin was the most common and physiological jaundice was the least common. Amongst infectious skin disorders, ophthalmia neonatorum (23.3%) was the most common and breast abscess (0.1%) was the least common. Amongst non-infectious skin disorders, miliaria crystallina (35.3%) was the most common and sclerema neonatorum (0.1%) was the least common. Amongst developmental defects, Salmon patch (19%) was the most common and Spina bifida (0.1%) was the least common. Out of 5820 physiological skin changes, maximum (3716) appeared on the first day and minimum (109) appeared on the seventh day of life. Out of 890 infectious and non-infectious skin changes, the lesions appeared with an equal frequency throughout the 7 days.

CONCLUSION

Physiological skin changes were found more commonly than pathological skin changes, and the ratio between physiological to pathological skin changes was 5.8: 1.1. Physiological skin changes varied significantly with neonatal and maternal factors, while most of the pathological skin changes did not vary with the above factors. The parents can be assured that their babies will develop some skin lesions during their early neonatal period. Most of them will disappear spontaneously or with minimal treatment. Rarely, immediate intervention is required.

KEYWORDS

Physiological and Pathological Skin Changes, Neonatal and Maternal Factors, Day of Appearance.

How to cite this article

Sharma P, Behera A. Skin changes in neonates during early neonatal period. J. Evolution Med. Dent. Sci. 2017;6(93):6695-6702, DOI: 10.14260/jemds/2017/1450

BACKGROUND

The early neonatal period is considered to be the first 7 days of life after birth. The skin undergoes a variety of changes during this period, which reflects the neonates’ functional adaptability to its new environment. These changes resolve spontaneously within a few weeks and are regarded as physiological.(1) Skin changes other than physiological are called pathological. These pathological changes are either transmitted from the parents or acquired from the external environment.

Changes acquired from the external environment reflect the baby’s immature immune system or inability to adapt itself to its new environment.(2)

Both physiological and pathological skin changes during the early neonatal period cause a lot of concern amongst the parents. So, it becomes important to identify these changes correctly and allay the fears of the parents.

Aims and Objectives

  1. To determine the relative incidence of various physiological and pathological skin changes during the early neonatal period.
  2. To study the maternal and neonatal factors responsible for these changes.
  3. To determine the time of appearance and disappearance of these skin changes.
  4. The incidence of skin changes, its relation to maternal and neonatal factors and the time of their appearance and disappearance will be compared with earlier studies.

Review of Literature

The skin of a neonate differs from that of an adult, both anatomically and physiologically. At birth the skin is covered by vernix caseosa.(3) After its removal, the skin looks intensely erythematous, smooth and soft in texture. Peripheral cyanosis is present at birth and is more marked on the palms, soles and around the mouth. After a few hours of birth, some babies develop harlequin colour change and cutis marmorata.(1) Sebaceous hyperplasia, milia, Epstein’s pearls and Mongolian spots are present in a majority of neonates at birth or a few hours thereafter.(4)

The influence of maternal hormones on the foetus gives rise to numerous changes, which have been described as ‘miniature puberty.’ In the newborn females, the genitalia appear succulent with a large clitoris and mucoid vaginal discharge, which is followed by frank withdrawal bleeding. The male genitalia appear similarly large and well developed at birth. Both sexes show hypertrophy of the mammary glands and pigmentation of linea alba at birth.(5)

Hair loss over the scalp starts immediately after birth over the frontoparietal area producing an area of alopecia, that is analogous to adult male pattern alopecia. Physiological desquamation of the skin usually starts over the extremities by the 3rd or 4th day of life and then spreads to involve the entire body.(6) Physiological jaundice, which is manifested as yellowing of eyes and skin, is also seen during this period. Transient erythematous and pustular lesions in the form of erythema toxicum neonatorum, transient neonatal pustular melanosis and infantile acropustulosis usually starts on the 2nd or 3rd day of life.(7)

Infants born before 37th week of gestation are considered as preterm infants. These infants are usually smaller in size, with thin, translucent skin and covered by lanugo hairs. The breast nodule, ear cartilage, genitalia and deep plantar creases are poorly developed. The postmature babies, i.e. infants born after 42 weeks of gestation are usually covered by greenish vernix caseosa. The skins of these babies are usually dry and parchment like.(8)

The pathological skin manifestations may be classified into infective skin disorders, non-infective skin dermatoses, genodermatoses and developmental skin defects.

Infective skin disorders can be caused by bacterial, fungal or viral infections. Bacterial infections include bullous impetigo, periporitis staphylogenes, staphylococcal scalded skin syndrome, ophthalmia neonatorum, necrotising fasciitis, omphalitis and breast abscess.(9) Fungal infections include oral and cutaneous candidiasis.(10) Viral infections like herpes simplex and varicella are rarely seen in neonates.

The non-infective skin dermatoses include miliaria, eczematous eruptions,(11) diseases of subcutaneous fat,(12) dermatoses acquired transplacentally and birth traumatic lesions.

The developmental skin defects include naevi, spina bifida and cleft lip. Vascular naevi like salmon patch,(13) port wine stain and strawberry haemangioma are seen at birth. Congenital melanocytic naevi, verrucous epidermal naevi and sebaceous naevi are occasionally seen at birth.(14)

Genodermatoses like ichthyosis, aplasia congenita cutis, epidermolysis bullosa, incontinentia pigmenti, erythropoietic porphyria and mastocytosis are also present.(15)

Cutaneous disorders of neonates were first described by Ballantyne (1895). Since then many reports have appeared in the literature.(4),(5),(8),(16),(17),(18),(19),(20) The factors influencing the pattern of cutaneous changes include climate, race, heredity, hygiene, maternal factors like mother’s age and parity and neonatal factors like gestational age, sex and birth weight.

MATERIALS AND METHODS

1000 live-born babies delivered in labour room in 1 year period were selected for the present study. Babies who could remain in the hospital for at least 7 days were included in the study. This included babies delivered by CS, forceps and babies delivered vaginally, whose mothers remained in hospital for PPS. Mother’s and baby’s personal details were recorded. Cutaneous, General and Systemic examination of all babies were done. Babies were followed up daily till the next 7 days.

Laboratory examination like Gram staining, Wright’s staining, Tzanck test, KOH preparation, culture and biopsy for histopathological examination were done whenever necessary.

 

Sampling Method

Convenience sampling technique.

 

Sample Size

1000.

 

Study Design

Prospective observational study.

 

Statistical Method

Descriptive Statistics, Chi-square test, software used is SPSS 20.0 version.

 

RESULTS

 

Birth

Mother’s Number

Percentage

Babies’ Number

Percentage

Single

964

98.3

964

96.4

Twins

15

1.5

30

3

Triplets

2

0.2

6

0.6

Total

981

100

1000

100

Table I. Demography of Mothers and Neonates

 

Table I shows that 1000 neonates selected for study were born to 981 mothers, 98.3% of them delivered a single baby, 1.5% delivered twins and 0.2% delivered triplets.

 


Sex

Number

Percentage

Male

501

50.1

Female

499

49.9

Total

1000

100

Table II. Sex Distribution of Neonates

 

 

Gestational Age

Number

Percentage

Term

789

78.9

Post-term

110

11.0

Pre-term

101

10.1

Total

1000

100

Table III. Gestational Age Distribution of Neonates

 

Table II and Table III shows that out of 1000 neonates there were 50.1% males and 49.9% females, while 78.9% were term babies, 11% were post-term babies.

 

Birth Weight

in Grams

Number

Percentage

< 2500

204

20.4

≥ 2500

796

79.6

Total

1000

100

Table IV. Birth Weight of Neonates

 

 

Mode of Delivery

Number

Percentage

Caesarean section

681

68.1

Normal vaginal

220

22

Forceps

99

9.9

Total

1000

100

Table V. Mode of Delivery of Neonates

 

 

Table IV and Table V shows that out of 1000 neonates, 20.4% weighed below 2500 gms and 79.6% weighed above 2500 gms, while 68.1% neonates were delivered by caesarean section, 22% by normal vaginal delivery and 9.9% by forceps application.

 

Sl. No.

Name of Skin Change

Number

Percentage

1

Physiological scaling

819

81.9

2

Recession of hair

756

75.6

3

Mongolian spots

698

69.8

4

Sebaceous hyperplasia

633

63.3

5

Sparse hair

586

58.6

6

Epstein’s pearls

560

56

7

Pigmentation of linea alba

552

55.2

8

Milia

491

49.1

9

Erythema toxicum neonatorum

233

23.3

10

Dense hair

190

19

11

Breast hypertrophy

164

16.4

12

Physiological jaundice

138

13.8

Table VI. Incidence of Physiological Skin Changes

 

Table VI shows that out of 1000 neonates, physiological desquamation of skin was the most common and physiological jaundice was the least common physiological skin changes. The incidence of physiological skin changes of our study was comparable with those of earlier workers. A high incidence of physiological desquamation, Mongolian spots, sebaceous hyperplasia and Epstein’s pearls was seen in all the studies (Mishra 1988, Nobbay 1992, Nanda 1989). A low incidence of physiological jaundice and breast hypertrophy was noted in our study, which was similar to earlier reports (Nobbay 1992, Nanda 1989). However, a high incidence of recession of hair, sparse hair and pigmentation of linea alba was noted in our study which was not reported by earlier workers.

 

Sl. No.

Name of Skin Change

Male

%

Female

%

Total

P-value*

Significant at 5% Level

1

Physiological scaling

400

79.8

419

83.97

819

0.90

No

2

Recession of hair

384

76.6

372

74.5

756

0.440

No

3

Mongolian spots

338

67.5

360

72.1

698

0.107

No

4

Sebaceous hyperplasia

358

71.5

275

55.1

633

<0.001

Yes

5

Sparse hair

354

70.7

232

46.5

586

<0.001

Yes

6

Epstein’s pearls

279

55.7

281

56.3

560

0.842

No

7

Pigmentation of linea alba

297

59.3

255

51.1

552

0.009

Yes

8

Milia

221

44.1

270

54.1

491

0.002

Yes

9

Erythema toxicum neonatorum

147

29.3

86

17.2

233

<0.001

Yes

10

Dense hair

79

15.8

111

22.2

190

0.009

Yes

11

Breast hypertrophy

78

15.6

86

17.2

164

0.477

No

12

Physiological jaundice

76

15.2

62

12.4

138

0.208

No

Table VII. Relation of Physiological Skin Changes to Neonate’s Sex

 

*Application of Chi-square Test.

 

Table VII shows that in the present study sebaceous hyperplasia, sparse hair, erythema toxicum neonatorum and dense hair showed a higher incidence among males, while milia and breast hypertrophy showed a higher incidence among female neonates. This was not reported by earlier workers.

Serial

No.

Name of Skin Change

Term

(n= 789)

Percent

Pre-Term

(n= 101)

Percent

Post-Term (n= 110)

Percent

Total

(n= 1000)

P-value*

Significant

at 5% Level

1

Physiological scaling

686

86.9

25

24.8

108

98.2

819

<0.001

Yes

2

Recession of hair

602

76.3

56

55.4

98

89.1

756

<0.001

Yes

3

Mongolian spots

556

70.5

51

50.5

91

82.7

698

<0.001

Yes

4

Sebaceous hyperplasia

489

61.98

83

82.2

61

55.5

633

<0.001

Yes

5

Sparse hair

459

58.2

52

51.5

75

68.2

586

0.042

Yes

6

Epstein’s pearls

460

58.3

51

50.5

49

44.5

560

0.012

Yes

7

Pigmentation of linea alba

409

51.8

73

72.3

70

63.6

552

<0.001

Yes

8

Milia

422

53.5

26

25.7

43

39.1

491

<0.001

Yes

9

Erythema toxicum neonatorum

180

22.8

14

13.9

39

35.6

233

0.001

Yes

10

Dense hair

163

20.7

21

20.8

6

5.5

190

0.001

Yes

11

Breast hypertrophy

143

18.1

5

4.95

16

14.5

164

0.003

Yes

12

Physiological jaundice

101

12.8

24

23.8

13

11.8

138

0.009

Yes

Table VIII. Relation of Physiological Changes to Gestational Age of Neonate

 

*Application of Chi-square Test.

 

Table VIII shows that Preterm babies showed a higher incidence of sebaceous hyperplasia (Nanda 1989) and physiological jaundice (Dutta 1989) and a lower incidence of physiological scaling, milia (Mishra 1985), erythema toxicum neonatorum (LaVoo 1994) and breast hypertrophy (Rudoy 1975), which corresponds with the earlier studies. Preterm babies showed a higher incidence of pigmentation of linea alba and a lower incidence of hair recession and Mongolian spots which was not reported earlier. Post-term babies showed a higher incidence of sparse hair and physiological scaling (Wagner 1995), which was seen in earlier studies. Term babies showed a significantly higher incidence of Epstein’s pearls, which was not reported earlier.

Serial No.

Name of Skin Change

< 2500 g

Percent

≥ 2500 g

Percent

Total

P-value*

Significant at

5% Level

1

Physiological scaling

140

68.6

679

85.3

819

<0.001

Yes

2

Recession of hair

145

71.1

611

76.6

756

0.92

No

3

Mongolian spots

154

75.5

544

68.3

698

0.047

Yes

4

Sebaceous hyperplasia

153

75

480

60.3

633

<0.001

Yes

5

Sparse hair

133

65.2

453

56.9

586

0.032

Yes

6

Epstein’s pearls

126

61.8

434

54.5

560

0.063

No

7

Pigmentation of linea alba

107

52.5

445

55.9

552

0.376

No

8

Milia

101

49.5

390

49

491

0.896

No

9

Erythema toxicum neonatorum

23

11.3

210

26.4

233

<0.001

Yes

10

Dense hair

38

18.6

152

19.1

190

0.879

No

11

Breast hypertrophy

17

8.3

147

18.5

164

<0.001

Yes

12

Physiological jaundice

34

16.7

104

13.1

138

0.183

No

Table IX. Relation of Physiological Skin Changes to Neonates Birth Weight

 

*Application of Chi-square Test.

 

Table IX shows that Neonates weighing above 2.5 kg showed a higher incidence of erythema toxicum neonatorum (Rohr 1975, Kulkarni 1996), which was also reported in earlier studies. In our study neonates weighing below 2.5 kg showed a higher incidence of sebaceous hyperplasia, while neonates weighing above 2.5 kg showed a higher incidence of physiological scaling and breast hypertrophy which was not reported earlier. Kulkarni (1996) reported a higher incidence of Epstein’s pearls in neonates weighing above 2.5 kg, which was not observed in our study.

Serial No.

Name of Skin Disorder

Number of Neonates

Percentage

1

Ophthalmia neonatorum

233

23.3

2

Bullous impetigo

89

8.9

3

Oral candidiasis

26

2.6

4

Periporitis staphylogenes

17

1.7

5

Breast abscess

1

0.1

Table X. Incidence of Infectious Skin Disorders

 

Table X shows that out of 1000 neonates, ophthalmia neonatorum (23.3%) was the most common and breast abscess (0.1%) was the least common infectious skin disorders. The high incidence of Bullous impetigo, Oral candidiasis and Breast abscess of the present study was comparable with those of earlier workers (Rudoy 1975, Nanda 1989, Nobbay 1992). The high incidence of Ophthalmia neonatorum (23.3%) and Periporitis staphylogenes (1.7%) was not mentioned previously.

 

Serial

No.

Name of Skin Change

Term

(n= 789)

Percent

Pre-Term

(n= 101)

Percent

Post-Term (n= 110)

Percent

Total

(n= 1000)

P-value*

Significant

at 5% Level

1

Ophthalmia neonatorum

184

23.3

25

24.8

24

21.8

233

0.880

No

2

Bullous impetigo

80

10.1

3

2.97

6

6

89

0.024

Yes

3

Oral candidiasis

8

1

6

5.9

12

12

26

<0.001

Yes

4

Periporitis staphylogenes

13

1.6

3

2.97

1

1

17

0.497

No

5

Breast abscess

1

0.1

0

0

0

0

1

0.875

No

Table XI. Relation of Infectious Skin Disorders to Gestational Age of Neonate

 

*Application of Chi-square Test.

Table XI shows that term neonates showed a significantly higher incidence of bullous impetigo, while post-term neonates showed a significantly higher incidence of oral candidiasis. However, infectious skin disorders of neonates did not vary significantly with neonates’ sex and birth weight or with mother’s age and parity.

 

Serial No.

Name of Skin Disorder

Number of Neonates

Percentage

1

Miliaria crystallina

353

95.3

2

Scalp ecchymosis

71

7.1

3

Perianal dermatitis

56

5.6

4

Miliaria rubra

24

2.4

5

Caput succedaneum

9

0.9

6

Sclerema neonatorum

1

0.1

Table XII. Incidence of Non-Infectious Skin Disorders

Table XII shows that out of 1000 neonates, miliaria crystallina (35.3%) was the most common and sclerema neonatorum (0.1%) was the least common non-infectious skin disorders. The high incidence of Scalp ecchymosis, Perianal dermatitis, Miliaria rubra and Sclerema neonatorum of our study corresponded with the earlier studies (Nanda 1989, Rivers 1990, Nobbay 1992). The incidence of Miliaria crystallina was higher and that of Caput succedaneum lower than previous studies (Nanda 1989), probably because our study was done in a hot environment and forceps delivery was less.

 

Serial No.

Name of

Skin Change

Term

(n= 789)

%

Pre-Term

(n= 101)

%

Post-Term (n= 110)

%

Total

(n= 1000)

P-value*

Significant at 5% Level

1

Miliaria crystallina

288

36.5

26

25.7

39

35.5

353

0.103

No

2

Scalp ecchymosis

51

6.5

3

3

17

15.5

71

0.001

Yes

3

Perianal dermatitis

30

3.8

18

17.8

8

7.3

56

<0.001

Yes

4

Miliaria rubra

15

1.9

0

0

9

8.2

24

<0.001

Yes

5

Caput succedaneum

6

0.8

0

0

3

2.7

9

0.660

No

6

Sclerema neonatorum

0

0

1

0.1

0

0

1

0.012

Yes

Table XIII. Relation of Non-Infectious Disorders to Gestational Age of Neonate

 

Table XIII shows that preterm neonates showed a significantly higher incidence of perianal dermatitis, probably due to increased skin fragility. Preterm neonates showed a significantly lower incidence of miliaria crystallina. Post-term neonates showed a significantly higher incidence of scalp ecchymosis.

 

 

Sl. No.

Name of Skin

Disorder

Number of Neonates

%

1

Salmon patch

190

19.0

2

Café-au-lait macules

5

0.5

3

Congenital melanocytic

nevus

3

0.3

4

Port wine stain

2

0.2

5

Cleft lip

2

0.2

6

Epidermal nevus

1

0.1

7

Skin tags

1

0.1

8

Spina bifida

1

0.1

Table XIV. Incidence of Developmental Defects

 

Table XIV shows that out of 1000 neonates, Salmon patch (19%) was the most common and Spina bifida (0.1%) was the least common developmental defects. The incidence of Salmon patch in our study was significantly lower than the studies carried out by earlier workers (Dickson 1979, Nanda 1989, Rivers 1990). In our study a significantly higher incidence of Salmon patch was seen among males, neonates weighing below 2.5 kg and in primiparas which was not reported earlier. In the present study, the incidence of Congenital melanocytic nevus (Mayerhofer 1927), Port wine stain (Jacobs 1976), Cleft lip, Epidermal nevus (Rivers 1990), Skin tags and Spina bifida (Nanda 1989) was comparable with the findings of earlier workers.

 

Sl. No.

Name of Skin Changes

Birth and 1st Day

2nd Day

3rd Day

4th Day

5th Day

6th Day

7th Day

1

Physiological scaling

*

*

145

127

256

182

109

2

Recession of hair

671

37

28

20

*

*

*

3

Mongolian spots

464

234

*

*

*

*

*

4

Sebaceous hyperplasia

568

37

28

*

*

*

*

5

Sparse hair

441

87

19

39

*

*

*

6

Epstein’s pearls

540

9

11

*

*

*

*

7

Pigmentation of linea alba

394

73

85

*

*

*

*

8

Milia

378

40

73

*

*

*

*

9

Erythema toxicum neonatorum

29

107

68

29

*

*

*

10

Dense hair

145

18

27

*

*

*

*

11

Breast hypertrophy

86

52

26

*

*

*

*

12

Physiological jaundice

*

*

26

95

17

*

*

13

Total

3716

694

536

310

273

182

109

14

Percentage

63.9

11.9

9.2

5.3

4.7

3.1

1.9

Table XV. Days of Appearance of Physiological Skin Changes

 

Table XV shows that out of 5820 physiological skin changes seen among 1000 neonates, maximum number (3716) appeared on the first day and minimum number (109) appeared on the seventh day of life. Most of the lesions of Mongolian spots, recession of hair, sebaceous hyperplasia, sparse hair, Epstein’s pearls, pigmentation of linea alba, milia, dense hair and breast hypertrophy appeared on the first day. Majority of the lesions of erythema toxicum neonatorum, physiological jaundice and physiological scaling appeared on 2nd, 4th and 5th day respectively. In our study, physiological scaling appeared from 3rd day onwards reaching a peak on 5th day, which was in contrast to other studies where it appeared on 1st day (Hodgman 1971, Atherton 1992). The hot weather condition prevailing in our area of study could be the result of this discrepancy. 67% of Mongolian spots were seen on the 1st day of our study, which was significantly lower than earlier studies (Dickson 1979). Most of our babies were of dark skin, making it difficult to observe Mongolian spots at birth. As the Mongolian spots darkened after birth, a significantly higher incidence was observed on the 2nd day.

The day of appearance of hair recession, sebaceous hyperplasia, sparse hair, milia, dense hair, rash of erythema toxicum neonatorum and physiological jaundice were similar to earlier studies (Steigleder 1963, Nanda 1989, Rivers 1990). 94% Epstein’s pearls, 71.4% pigmentation of linea alba and 52% breast hypertrophy were observed on the 1st day, which was not reported by earlier workers.

 

Sl. No.

Name of Skin Disorders

Birth and 1st Day

2nd Day

3rd Day

4th Day

5th Day

6th Day

7th Day

1

Miliaria crystallina

91

109

38

24

24

38

29

2

Ophthalmia neonatorum

36

62

63

54

9

*

9

3

Bullous impetigo

*

*

*

39

25

6

19

4

Scalp ecchymosis

71

*

*

*

*

*

*

5

Perianal dermatitis

*

*

*

10

11

14

21

6

Miliaria rubra

*

17

13

4

*

*

*

7

Oral candidiasis

*

*

*

10

3

6

7

8

Periporitis staphylogenes

*

*

4

13

*

*

*

9

Caput succedaneum

9

*

*

*

*

*

*

10

Breast abscess

*

*

*

*

*

*

1

11

Sclerema neonatorum

*

1

*

*

*

*

*

12

Total

207

189

118

154

72

64

86

13

Percentage

23.2

21.2

13.3

 

8.1

7.2

9.7

Table XVI. Day of Appearance of Pathological Skin Manifestations

 

Table XVI shows that out of 890 infectious and non-infectious skin changes seen among 1000 babies, the lesions appeared with an equal frequency throughout the 7 days. Lesions of malaria crystalline appeared on all 7 days of life. Ophthalmia neonatorum was more frequently seen on first 4 days of life. Lesions of bullous impetigo, oral candidiasis and perianal dermatitis appeared between 4th to 7th day of life. Lesions of Miliaria rubra appeared on 2nd to 4th day, while lesions of Periporitis staphylogenes appeared on 3rd to 4th day of life. Only one case of breast abscess was seen and it appeared on the 7th day, while one case of sclerema neonatorum was seen on 2nd day.

The day of appearance of Miliaria crystalline, Bullous impetigo, Oral candidiasis, Breast abscess and Sclerema neonatorum was similar to earlier studies (Smith 1965, Hodgman 1971, Rudoy 1975, Atherton 1992, Wagner 1995). Pratt et al (1951) reported that the lesions of Perianal dermatitis appeared on the 1st day, while we found that it appeared between 4th - 7th day. We found that the lesions of Miliaria rubra appeared between 2nd to 4th day and those of Ophthalmia neonatorum appeared on the first 4 days of life which was not reported earlier.

 

Skin Changes

 

No. of Neonates

%

No. of Neonates

%

Physiological

 

 

 

5820

84.3%

Pathological

Infectious

366

5.3%

 

 

 

Non- Infectious

514

7.4%

 

 

 

Develop-mental

205

3%

 

 

Total Pathological

 

 

 

1085

15.7%

Total Skin Changes

 

 

 

6905

100%

Table XVII. Total Skin Changes in 1000 Neonates

 

Table XVII shows that 6905 skin changes were observed in 1000 neonates at an average of 6.9 lesions per neonate. There were 5820 (84.3%) physiological skin changes and 1085 (15.7%) pathological skin changes. Pathological skin changes include 366 (5.3%) infectious, 514 (7.4%) non-infectious and 205 (3%) developmental defects.

 

Skin Lesions requiring No Treatment

Number of Neonates

%

Physiological skin changes

5820

90.9%

Developmental defects other than spina bifida and cleft lip

202

3.2%

Miliaria crystallina

353

5.5%

Miliaria rubra

24

0.4%

Total

6399

100%

Table XVIII. Skin Lesions requiring No Treatment

 

Table XVIII shows that out of 6905 skin changes, 6399 skin lesions (92.7%) required no treatment. Out of 6399 skin lesions, 5499 skin lesions (83%) disappeared within 3 - 4 days. Mongolian spots (698) and lesions of Developmental defects (202) remained even after one week. Most of Mongolian spots disappeared between 6 to 12 months. Salmon patch becomes lighter within the first week and usually disappears by 1 month. Skin tags also disappear spontaneously or it can be removed. Café-au-lait macules, Port wine stain, CMN and Epidermal nevus remains for life and can be treated for cosmetic purpose.

Skin Lesions requiring Treatment

Number of Neonates

Percentage

Ophthalmia neonatorum

233

46.0%

Bullous impetigo

89

17.6%

Oral candidiasis

26

5.1%

Periporitis staphylogenes

17

3.4%

Breast abscess

1

0.2%

Scalp ecchymosis

71

14.0%

Perianal dermatitis

56

11.1%

Caput succedaneum

9

1.8%

Cleft lip

2

0.4%

Sclerema neonatorum

1

0.2%

Spina bifida

1

0.2%

Total

506

100%

Table XIX. Skin Lesions requiring Treatment

Table XIX shows that out of 6905 skin changes, 506 (7.3%) lesions required some treatment. Cleft lip is treated surgically. Spina bifida should be surgically operated immediately after birth. Amongst the skin lesions which required treatment, only baby with sclerema neonatorum was treated in NICU. Some of the Babies with Caput succedaneum were irritable. So babies with Caput succedaneum were kept under strict observation. Rest of the babies recovered within 5 days after topical treatment.

 

DISCUSSION

Physiological skin changes were found more commonly than pathological skin changes and the ratio between physiological to pathological skin changes was 5.8: 1.1. Physiological skin changes varied significantly with neonatal and maternal factors, while most of the pathological skin changes did not vary with the above factors. The incidence of physiological and pathological skin changes in our study, their relation to maternal and neonatal factors and the time of their appearance and disappearance corresponded to that of earlier studies.

Most of the pathological skin disorders were either acquired from the external environment or transmitted genetically from the parents. Thus, maintenance of good hygiene with appropriate prenatal investigations will prevent the occurrence of the pathological skin changes. In our study, it was seen that only 2 out of 6905 skin lesions required immediate intervention. So, we can assure the parents that all babies will develop some or the other skin lesions during their early neonatal period. Most of them will disappear spontaneously or with minimal treatment. Rarely immediate intervention is required. Parents should observe whether their babies are irritable, constantly crying, not drinking milk or having cold extremities and bring it to doctor’s notice. They should not unnecessarily observe and fiddle with the skin lesions. Nothing should be applied or fed to the baby.

CONCLUSION

Physiological skin changes were found more commonly than pathological skin changes and the ratio between physiological to pathological skin changes was 5.8: 1.1. Physiological skin changes varied significantly with neonatal and maternal factors, while most of the pathological skin changes did not vary with the above factors. The parents can be assured that their babies will develop some skin lesions during their early neonatal period. Most of them will disappear spontaneously or with minimal treatment. Rarely immediate intervention is required.

 


 

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