Skin findings are common during newborn screening. Although these findings are often benign, It is important to visualize the entire skin surface to recognize these findings and reassure parents appropriately.
- The newborn baby will have the following appearance immediately after birth:
- It has red or dark purple skin and bluish hands and feet. The skin darkens before the baby takes his first breath (when he makes his first strong cry). A thick, waxy substance called vernix covers the skin. This substance protects the fetus’s skin from the amniotic fluid present in the uterus. The paint should be washed off during the baby’s first bath. Fine, soft hair (langue) may cover the scalp, forehead, cheeks, shoulders and back. This is more common when the infant is born prematurely. The hair should disappear within the first few weeks of the baby’s life. A newborn’s skin varies depending on the length of pregnancy. Premature babies have thin, translucent skin. A full-term infant’s skin is thicker.
- By the second or third day of the baby’s life, The skin becomes a bit lighter and may become dry and flaky. The skin often turns red when an infant cries. Lips, hands, and feet may turn blue when a baby is cold.
- The infant should be as comfortable as possible so that the doctor can detect any abdominal masses more easily. Which is often renal in origin. A single umbilical artery may be associated with other congenital anomalies, Especially renal abnormalities, Intrauterine growth restriction, prematurity and any reproductive signs.
- Sacral dimples do not require further evaluation if they are less than 0.5 cm in diameter. It is located within 2.5 cm of the anal edge. It is not associated with skin marks; Boils that do not meet these criteria require an ultrasound to evaluate for spina bifida dysfunction
- Brachial plexus injuries are most common in newborns who are large for gestational age. Physical therapy may be required to achieve normal function.
- Patients who have abnormal results on the Ortolani and Barlow maneuvers should be further evaluated for hip dysplasia. It is also important to evaluate the newborn for tone and confirm the presence of normal primitive reflexes.
- When examining a newborn baby, we must examine his skin for any signs that may be strange, such as pimples, for example.
- Pimples: It is a type of skin rash that resembles small, flat freckles that are visible under the skin and cannot be bleached. By bleaching, we mean that when you press on the skin, the effect of the rash disappears.
- In case of blisters, We will see red or purple spots on the skin with a diameter of 1 to 2 mm that cannot be felt by touch, that is, they are not noticeable.
- Blisters may be a sign of sepsis, or the presence of bacteria in the blood that causes severe symptoms. This condition is considered an emergency and threatens the infant’s life and must be evaluated and treated immediately.
- Another important skin condition that we should not ignore is what is called purpura. Purpura is just like a pimple, but it is larger, perhaps a few centimeters across, but it is just like a pimple, except that it can be felt by running our finger over it. It may also be a sign of a serious illness such as sepsis, and the infant needs immediate examination and treatment. It may be a sign of shock, and this also indicates the need for immediate evaluation by a pediatrician.
- Another way to examine the skin is by gently pressing on the fingers or toes. So the skin color should fade to white and soon return to its natural color again. This is called capillary refilling.
- In the case of a normal child, The capillaries return to filling quickly after the pressure on the hand or foot ends.
- In the case of a child who suffers from poor blood circulation due to his illness, It may take more than two seconds for the fingers to refill the capillaries with blood.
- If the child’s capillary refill time is greater than two seconds, medical intervention is necessary.
- In addition, If there are other signs of illness in the child, such as fever and a very rapid capillary refill time, this may indicate that the child is suffering from sepsis due to bacteria in the blood and needs immediate treatment.
- Other changes may include:
- Milia (small, pearly white, firm, raised bumps on the face) that go away on their own. Mild acne that often goes away within a few weeks. This happens because some of the mother’s hormones remain in the baby’s blood.
- Erythema toxicum. This is a common and harmless rash that looks like small pimples on a red base. It tends to appear on the face, trunk, legs, and arms about one to three days after birth. It disappears for one week.
- Colored birthmarks or skin tags may include:
- Congenital nevi are moles (dark-colored skin marks) that may be present at birth. They range in size from as small as a pea to large enough to cover an entire arm or leg, or a large portion of the back or torso. Larger moles carry a greater risk of skin cancer. A health care provider should keep an eye on all moles. Mongolian spots are blue-gray or brown spots. It can appear on the skin of the buttocks or back, especially in children with dark skin. It should fade within a year.
- Café-au-lait spots are light tan in color, Like the color of coffee with milk. Often appears at birth, Or it may develop during the first few years. Children who have many of these spots may have, or large spots, You are more likely to develop a condition called neurofibromatosis.
- Red birthmarks may include:
- Port-wine stains – growths containing blood vessels (vascular growths). Its color is red to purple. They appear most frequently on the face, but may occur in any area of the body. Hemangiomas – a group of capillaries (small blood vessels) that may appear at birth or a few months later.
- Stork bites – small red spots on the child’s forehead, Or his eyelids, Or the back of his neck, Or his upper lip. It is caused by an aneurysm. It usually disappears within 18 months.
- After examining the skin, the child’s head must be examined and made sure that the head bones appear normal and that they are flat and smooth, with caution being careful with the anterior fontanel area.
- Anterior fontanelle: It is the open space in the upper front part of the head and is not covered by bone. If it is swollen or abnormal, the child may suffer from a problem inside the brain and needs immediate examination.
- However, if it is soaked and the child has poor nutrition or low urine output, this may be a sign of dehydration.
- The neck must also be examined without harming the child and make sure that he can easily move it from side to side and bend it forward.
- Children who suffer from a brain infection called meningitis may develop neck stiffness, so immediate examination is necessary to begin treatment.
- Although benign conditions are common at this period of life, However, the clinical manifestations can be more exaggerated and dramatic and cause a great deal of anxiety for parents. Therefore, as a doctor, Knowing the common, pathological and non-pathological skin rashes directs the family in the right direction. To start a sound treatment plan at the appropriate time
Prepared by: Dalal idris
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