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Neonatal Diseases PDF
Neonatal Diseases PDF
TOPICS
Erythema Toxicum Neonatorum
Miliaria
Cutis Marmorata Hemangioma of Infancy
Urticaria Pigmentosa
Congenital Syphilis
Erythematous macules, some with a tiny central papulopustule on the arm of a 1-day-old newborn.
Bacterial Folliculitis
Neonatal Herpes Scabies
Andrews' Diseases of the Skin 10th Ed. p. 140 Fitzpatrick Dermatology 7th Ed. p. 937
MILIARIA
Retention of sweat as a result of occlusion of eccrine sweat ducts. Common in hot humid climates.
Rupture of gland or duct at different levels
Escape of sweat
MILIARIA
FOUR TYPES:
Miliaria Crystallina
Miliaria Rubra
Miliaria Pustulosa
Miliaria Profunda
MILIARIA CRYSTALLINA
Aka Miliaria Sudamina Asymptomatic; Duration short PE:
- superficial, sub-corneal, non-inflammatory vesicles that easily rupture when rubbed with a finger.
Self-limited; No treatment required.
Andrews' Diseases of the Skin 10th Ed. p.23 Fitzpatrick Dermatology 7th Ed. p. 730
MILIARIA RUBRA
Aka Prickly Heat Obstructed sweat migrates into the epidermis and upper dermis causing pruritic inflammatory papules around the sweat pores. Sites: antecubital and popliteal fossae, trunk, inframammary areas, abdomen (waistline) and inguinal regions.
Andrews' Diseases of the Skin 10th Ed. p. 23 Fitzpatrick Dermatology 7th Ed. p. 730
MILIARIA RUBRA
PE: - discrete extremely pruritic, erythematous papulovesicles accompanied by a sensation of prickling, burning or tingling. Eruption subsides after the patient moves to a cool environment.
Andrews' Diseases of the Skin 10th Ed. p.23 Ffitzpatrick Dermatology 7th Ed. p. 730
CUTIS MARMORATA
Physiologic mottling of the skin. Transient and common finding in newborns. Aka marbled skin because of its mottled bluish discoloration. Commonly seen on lower extremities. Disappears when extremities are warmed.
CUTIS MARMORATA
Caused by instability or immaturity of the nerve supply to the superficial capillary blood vessels in the skin.
This causes the blood vessels in some regions of the skin to dilate.
http://doctorsgates.blogspot.com/2011/03/mottled-skin-or-cutis-marmorata-in.html
HEMANGIOMA OF INFANCY
Aka Strawberry Hemangioma
Most common tumor of infancy. Females > Males 3:1 ratio
Etiology: localized proliferative process of angioblastic mesenchyme (embryonic mesenchymal tissue from which blood cells and blood vessels arise).
Course of Lesion: Initial proliferation phase lasts 3 to 9 months. Enlarge rapidly during 1st year. Regresses gradually over 2 to 6 years and is usually complete by the age of 10.
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology 5th Ed. p. 180
HEMANGIOMA OF INFANCY
PE: - Soft, bright red to deep purple On diascopy, does not blanch completely With onset of spontaneous, white-to-gray area appears on the surface of the central part of the lesion Usually solitary and locaized or extend over an entire region. Head and neck 50%, Trunk 25%
Distribution: -
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology 5th Ed. p. 180
HEMANGIOMA OF INFANCY
SPECIAL PRESENTATIONS 1. Deep Hemangioma - aka Cavernous Hemangioma - localized, firm rubbery mass of bluish color with telangiectases in overlying skin. - lower dermis and subcutaneous fat.
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology 5th Ed. p. 180
HEMANGIOMA OF INFANCY
2. Multiple HIs - multiple small (<2cm), cherry red papular lesions involving skin alone ( benign cutaneous hemangiomatosis) or skin and internal organs (diffuse neonatal hemangiomatosis).
HEMANGIOMA OF INFANCY
3. Congenital Hemangiomas
- develop in utero Subdivided: Rapidly involuting congenital hemangiomas (RICH)
HEMANGIOMA OF INFANCY
Dermatopathology: Proliferation of endothelial cells in various amounts in the dermis and/or subcutaneous tissue. Diagnosis: Clinical findings and MRI Doppler and arteriography fast flow Course and Prognosis: No residual skin change at the site in most lesions (80%). Residual atrophy, depigmentation, telangiectasia and scarring (20%). Deeper lesions may not involute completely (mucous membranes)
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology 5th Ed. p. 181
HEMANGIOMA OF INFANCY
Management: - Continuous wave or pulsed dye laser - Cryosurgery - Intralesional and systemic high dose glucocorticoids - INF- Majority of HIs active nonintervention is the best approach because spontaneous resolution gives the best cosmetic results.
URTICARIA PIGMENTOSA
Generalized Eruption, Childhood Type Form of cutaneous mastocytosis Begins during the first weeks of life PE: Rose-colored, pruritic, urticarial, slightly pigmented macules, papules or nodules.
Oval or round and vary in diameter between 5 and 15mm and may coalesce
Varies from yellowish-brown to yellowish-red Occ. lesions are a pale yellow color (Xanthelasmoidea)
URTICARIA PIGMENTOSA
PE: Vesicle and Bulla formation prominent feature early in the disease Not evanescent Lesions persist and gradually become chamois or slatecolored
URTICARIA PIGMENTOSA
Dariers Sign - Firmly stroked or vigorously rubbed, urticaria with a surrounding erythematous flare usually develops
CONGENITAL SYPHILIS
Acquired in utero Infection through the placenta usually does not occur before the 4th month.
Pathogenesis:
- Lesions usually develop after 4th month of gestation. - Associated with fetal immunologic competence (depends on immune response of fetus) Adequate treatment before 16th week prevents fetal damage Untreated fetal loss up to 40%
Andrews' Diseases of the Skin 10th Ed. p.360 Fitzpatricks Color Atlas & Synopsis of Clinical Dermatology 5th Ed. p. 924
CONGENITAL SYPHILIS
CLINICAL MANIFESTATIONS: Early Congenital Syphilis within first 2 years of life Late congenital Syphilis after the age of 2 years
Condylomata Lata
Large, moist, hypertrophic papules found about the anus and in the other folds of the body. More common around the first year of life than in the newborn period.
Causes pain on motion, leading to the infants refusing to move (Parrot pseudoparalysis)
Bone lesions occur at the epiphyseal ends of the long bones.
CNS involvement 86%; meningeal or meningovascular in origin (3rd to 6th month of life) Hepatomegaly, splenomegaly, enlargement of lymph nodes.
Interstitial Keratitis
-
Mulberry molar
Nasal Chondritis
Higoumenakis Sign
CONGENITAL SYPHILIS
Diagnosis: Infants of women who meet the following criteria should be evaluated for congenital syphilis: 1. Maternal untreated syphilis, inadequate treatment, or no documentation of adequate treatment. 2. Treatment of maternal syphilis with erythromycin. 3. Treatment less than 1 month before delivery. 4. Inadequate maternal response to treatment. 5. Appropriate treatment before pregnancy, but insufficient serologic follow-up to document adequacy of therapy.
CONGENITAL SYPHILIS
Management:
Therapy should be undertaken in consultation with a pediatric infectious disease specialist.
Recommended Evaluation:
1. CSF analysis for VDRL, cell count, and protein 2. Complete blood count (CBC) and differential and platelet count 3. Other tests as clinically indicated (e.g., long-bone radiographs, chest radiograph, liver-function tests, cranial ultrasound, ophthalmologic examination, and auditory brain stem response)
OR
Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
OR
Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days OR Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
1. mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and 2. mother has no evidence of reinfection or relapse.
* Another approach involves not treating the infant, but rather providing close serologic follow-up in those whose mothers nontreponemal titers decreased fourfold after appropriate therapy for early syphilis or remained stable or low for late syphilis.