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Figure 1.60. This infant has a typical pigmented skin dimple at the knee. The presence of a skin dimple over a joint, pigmented or not, is normal. Skin dimpling is frequently noted in a relatively mild form where there has been prolonged intrauterine pressure upon the bony prominences, particularly at the elbows and knees. Normal skin dimples are most commonly noted at the knee joints, over the lateral aspect of the elbows, over the acromion process, and in die lumbosacral area.
Neonatal Dermatology
The neonatal skin must be given careful consideration for several reasons - It is a protective organ, especially when covered with vernix. - Any break in integrity creates an opportunity for infection therefore, minimize skin trauma. - Absorption of agents through the skin, especially in premature infants, may have harmful effects e.g., hexachlorophene, Betadine , boric acid, etc. - The skin may be used therapeutically e.g., application of safflower oil for essential fatty acid deficiency ....
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Figure 1.81. Note that the nipples are in the 5th intercostal space in this otherwise normal infant. The nipple may be found anywhere along the milk line which extends from the axilla to the pubis. Normally the nipple is located at the 4th intercostal space. Figure 1.81. Note that the nipples are in the 5th intercostal space in this otherwise normal infant. The nipple may be found anywhere along the milk line which extends from the axilla to the pubis. Normally the nipple is located at the 4th...
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Figure 1.61. A pigmented skin dimple over the left shoulder. Normal skin dimples in general tend to occur in areas where the skin is relatively tightly bound to the underlying bony prominences. Figure 1.62. Nonpigmented skin dimples in die iliosacral area. These tend to be crease-shaped and may be multiple over the lower part of the back. If midline, they should be distinguished from a pilonidal sinus. Figure 1.61. A pigmented skin dimple over the left shoulder. Normal skin dimples in general...
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Figure 1.79. Another example of mastitis neonatorum which is asymmetrical in that it is more prominent on the right than on the left. Mastitis neonatorum is noted more frequently in postmature infants. It subsides spontaneously over die course of several weeks. Figure 1.80. This infant has inclusion cysts of the right nipple. These require no treatment as they resolve spontaneously. Figure 1.79. Another example of mastitis neonatorum which is asymmetrical in that it is more prominent on the...
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Figure 1.73. A baby with a tail. Vestigial tails are rarely seen in the neonate. They may consist of soft tissue only, as in this infant, or may contain osseous structures. Figure 1.74. Note the preauricu-lar and facial skin tags in this otherwise normal infant. Preauricular skin tags are extremely common, but the presence of skin tags between the ear and comer of the mouth would suggest a diagnosis of Goldenhar's syndrome. Figure 1.74. Note the preauricu-lar and facial skin tags in this...
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Figure 1.78. Mastitis neonatorum due to physiologic breast engorgement is the result of transplacental transfer of maternal estrogen to the fetus. Enlargement is generally symmetrical, as noted in this infant. Witch's milk which is chemically identical to colostrum may be expressed from the breasts, but it is not advisable to relieve the swelling by expressing the milk since infection may follow. Figure 1.78. Mastitis neonatorum due to physiologic breast engorgement is the result of...
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Figure 1.68. A midline occipital defect consisting of a tag with some cystic formation is seen in this infant. In any infant with a midline lesion anywhere from the back of the neck to the lower end of the spine, it is mandatory to investigate the neural axis. The lesions may consist of small sinuses, cysts, or hemangiomas. Figure 1.67. The large skin fold on the back of this infant was hard and fibrotic. It was believed to have occurred as a result of the skin being pinched in utero from...
Face Presentation
Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia. Figure 1.49. Skin incisions over the buttocks in an infant following cesarean birth. Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia.
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Figure 1.53. Subcutaneous fat necrosis of the cheek in an infant following forceps delivery. In subcutaneous fat necrosis, which is usually detected towards the end of the first week of life, the lesions have an inflammatory or ecchymotic appearance. The underlying tissue may be indurated and feels diffusely hardened. With breakdown of the subcutaneous tissue after several days there may be an area in the center which is fluctuant. If managed conservatively, spontaneous healing usually occurs....
Hypophosphatasia And Skin Dimples
Figure 1.63. Dimples in between the joints over the long bones are considered pathologic until proven otherwise. In this infant with congenital hypophosphatasia, the skin dimple over the middle of the tibia is a very typical finding. Abnormal aberrant skin dimples may occur at a location where there has been a closer than usual proximity between die skin and the underlying bone structure during fetal life, resulting in deficient development of subcutaneous tissue at that locus. Such dimples may...
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Figure 1.57. In this infant there were several attempts at performing a spinal tap for sepsis evaluation. Four days later he developed areas of subcutaneous fat necrosis over the lower lumbar area. These could easily have been mistaken for abscesses but were confirmed to be subcutaneous fat necrosis occurring from the pressure applied in performing the spinal tap. Note the mongolian spots. Figure 1.57. In this infant there were several attempts at performing a spinal tap for sepsis evaluation....
Sucking Blister Not Healed
Figure 1.38. Intrauterine sucking lesions sucking blisters may present as small intact or ruptured bullae and are most commonly seen on the radial surface of the wrist, dorsum of the hand, or dorsum of the fingers. If unruptured, as in this infant, they may be filled with sterile serous fluid or, if sucking is vigorous, there may be a hemorrhagic component. Intrauterine sucking lesions are an example of self-induced tissue disruption in a normal newborn the lesions are benign and require no...
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Figure 1.33. Milia occur commonly on the face of 25 to 40 of newborn infants. Histologically they are small superficial inclusion cysts that result from retention of keratin and sebaceous material within the pilosebaceous glands of the newborn, and appear as tiny 1-to 2-mm white or yellowish-white papules. The lesions are called milia because of their resemblance to millet seeds. Milia are particularly prominent on the cheeks, nose, chin, and nasolabial folds. The condition is self-limiting and...
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Figure 1.51. Suffusion of the face and head in an infant who had a tight nuchal cord. Note the difference in color of the face and head compared with the rest of the body. Figure 1.52. In this infant aged 6 days, note the healing abrasion from the application of forceps. In addition note the changes in the skin in that there is some reddish-purple discoloration and swelling with induration of the underlying subcutaneous tissue. This is an example of early subcutaneous fat necrosis. Subcutaneous...
Sebaceous Gland Hyperplasia
Figure 1.31. Sebaceous gland hyperplasia represents a physiologic phenomenon of the newborn manifested by multiple, yellow to flesh-colored tiny greasy-looking papules that occur on the nose, cheeks, and upper lips of full term infants. These papules, a manifestation of maternal androgen stimulation, represent a temporary disorder that resolves spontaneously within the first few weeks of life. Figure 1.32. A close-up view of sebaceous gland hyperplasia. Figure 1.32. A close-up view of sebaceous...
Forceps Delivery
Figure 1.44. Abrasion of the nose sheet burns in an infant with hyperactivity due to drug withdrawal. At the present time hyperactivity is most commonly seen with drug withdrawal, but may occur in infants experiencing pain, congenital hyperthyroidism, etc. The abrasions and erythema generally develop over prominent body parts such as the nose, ears, cheeks, elbows, and knees. Figure 1.45. Sheet burn of the cheeks in a hyperactive infant who was lying in a pool of regurgitated gastric contents....
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Figure 1.37. Infants with acne neonatorum have the typical facial distribution of the comedones seen in acne in adolescence. The chest and back are rarely involved. Neonatal acne appears to develop as a result of maternal androgen stimulation of sebaceous glands that have not yet involuted to their childhood state of immaturity. Acne neonatorum is a common, transitory, self-limiting disorder and should not be mistaken for an infection.
Foreword
Sir William Osler stated, There is no more difficult task in medicine than the art of observation. The late Arnold Jack Rudolph was an internationally renowned neonatolo-gist, a teacher's teacher, and, above all, one who constantly reminded us about how much could be learned by simply observing, in his case, the newborn infant. This color atlas of neonatology represents a distillation of more than 50 years of observing normal and abnormal newborn infants. The Atlas begins with a section on the...
Post Term Dermatology
Figure 1.11. The hand of die same infant as in Figure 1.1. showing die desquamation of the skin, long finger nails, and meconium staining. Figure 1.12. Marked desquamation of the skin in a post-term infant. This is a benign physiologic desquamation widi paper-thin peeling the underlying skin is normal. It occurs with postmaturity as the vernix disappears and the skin of the fetus is not protected from the amniotic fluid. The process is more marked in areas of irritation. Figure 1.11. The hand...
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Figure 1.42. In upper panel, note another example of scarring at the left wrist in a normal newborn from an intrauterine sucking lesion. Below, this infant continued sucking its wrist after birth at the site of this lesion. Figure 1.43. Facial abrasions in this infant were self-inflicted. This type of lesion results from hyperactivity in an infant with long finger nails and is seen more commonly in postmature infants and in infants with drug withdrawal.
Phototherapy Rash
Figure 1.17. In this infant note the maculopapular rash which followed phototherapy treatment for hyperbilirubinemia. This bilirubin rash improves rapidly following discontinuation of phototherapy. Figure 1.17. In this infant note the maculopapular rash which followed phototherapy treatment for hyperbilirubinemia. This bilirubin rash improves rapidly following discontinuation of phototherapy. Figure 1.18. Mongolian spots in a caucasian infant. Mongolian spots are a minor anomaly commonly found...
Erythema Toxicum
Figure 1.25. Close-up of the lesions in erythema toxicum neonatorum. The etiology is unknown but biopsy of the lesions show the presence of numerous eosinophils. It has been suggested that the presence of erythema toxicum is evidence of maturity. Figure 1.27. Lentigines are smooth, freckle-like, pigmented macules. They are usually present at birth, have a scattered distribution, and have been considered by some to be a manifestation of intrauterine erythema toxicum neonatorum. They usually...
Preface
I first became attracted to the idea of producing a color atlas of neonatology many years ago. However, the impetus to synthesize my experience and compile this current collection was inspired by the frequent requests from medical students, pediatric house staff, nurses and others to provide them with a color atlas of the clinical material provided in my slide shows. For the past few decades I have used the medium of color slides and radiographs as a teaching tool. In these weekly slide shows...
Vasomotor Instability Infant
Figure 1.20. Cutis marmorata is a common finding in normal infants. This fine reticulated mottled appearance is due to vasomotor instability and thus is more commonly seen in premature infants, but should also alert one to the possibility of sepsis, hypothyroidism, and central nervous system pathology. Figure 1.19. Mongolian spots in a black infant. The spots have no significance but are sometimes mistaken for bruises, causing a suspicion of child abuse. This should be kept in mind when...
Postmature Baby
Figure 1.2. Pigmentation of the areola of the nipple in a newborn infant. Pigmentation is more marked in black infants. Figure 1.2. Pigmentation of the areola of the nipple in a newborn infant. Pigmentation is more marked in black infants. Figure 1.3. Pigmentation at the base of the nails in a black infant. There may be little pigmentation of the skin in general at birth, but the finding of pigmentation at the base of the nails, pinnae of the ears, axilla, areolae of the nipples, genitalia, and...
Female Infant Genitals
Figure 1.8. Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not there was any meconium staining, certain areas such as the axilla, inguinal folds and genitalia, if not adequately cleaned, will reveal traces of the vernix. Figure 1.8. Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not there was any...
Postterm Newborn Skin
Figure 1.9. Meconium staining of the vernix and skin in an infant who had fetal distress with meco-nium-stained amniotic fluid. Figure 1.9. Meconium staining of the vernix and skin in an infant who had fetal distress with meco-nium-stained amniotic fluid. Figure 1.10. Note the meconium staining of the skin in a post-term infant. He also had marked desquamation of the skin as well as long finger nails, features common to the postmature infant.