This document discusses common neonatal skin problems and other issues that may arise in the first month of life. It outlines nine common neonatal skin lesions including milia, miliaria, erythema toxicum neonatorum, and transient neonatal pustular melanosis. It also discusses vasomotor instability issues, diaper dermatitis, and seborrheic dermatitis. Additionally, it covers problems such as vomiting, failure to pass meconium or urine, neonatal diarrhea, and their potential causes and treatments. The document provides an overview of typical neonatal health issues for medical professionals.

1. COMMON NEONATAL
PROBLEMS
Presented by:
Sreelakshmi.R

2. NEONATAL SKIN
 Thinner epidermis
 Higher epidermal proliferation and
desquamation rate.
 High transepidermal water loss
 Weaker intercellular attachment
 Increased susceptibility to external irritants
and microbial infections .

3. Neonatal skin lesion
1.MILIA
 white papules caused by
retention of keratin and
sebaceous material in the
pilaceous follicles .
 Frequently seen on nose ,
nasolabial fold and cheeks ,
resolves in first few weeks of
life.

4. 2.MILIARIA
 Due to obstruction of sweat ducts.
 Subdivided into 3 subtypes
depending on level of blockage :
1.Miliaria crystallina(stratum
corneum)
2.Miliaria rubra( mid epidermal)
3.Miliaria profunda (dermal-
epidermal junction)

5.  Predisposing factors: immature sweat ducts,
occlusive clothing, high heat and humidity
 Treatment:
Light clothing , cool bath and avoidance of
heavy blankets
Miliaria crystallina improves if the predisposing
etiological factors are taken care of.
Antibiotics may be needed if staphylococcal
infection , but this is rare.

6. 3.ERYTHEMA TOXICUM NEONATORUM
 Benign , self limiting disorder of unknown
etiology.
 One hypothesis represents an acute , innate
response to the penetration of skin colonizing
flora into the hair follicle.
 Most commonly on the trunk , face and
proximal parts (palms and soles not involved)

7.  Multiple erythematous
macules and papules(1-
3mm diameter) severe
cases progress to
pustules on an
erythematous base.
 Usually resolves in 5-7
days.

8. 4.TRANSIENT NEONATAL PUSTULAR
MELANOSIS
 Idiopathic pustular eruption that heals with
brown pigmented macules.
 Characterised by fragile pustules which
eventually rupture and form brown crust .

9.  Predominantly in chin, forehead, axilla and
nape of neck.
 Pustular lesions usually resolve within 24-
48hrs .Hyperpigmented macules may persist
for about 3 months.

10. 5.NEONATAL CEPHALIC PUSTULOSIS
 Pustular eruption on head and neck
 Occurs around 3wks of life.
 Resolves spontaneously without scarring in a
few months.

11.  Treatment: daily cleansing with soap and
water . Avoidance of exogenous oils and
lotions. 2% ketoconazole cream twice daily or
1% hydrocortisone cream once daily.

12.  Vasomotor Instability :
6. Harlequin colour change:
A self limited vascular phenomenon where
one half of body is dark red and other half is pale
colour. Often can be demonstrated by turning
child to side position.
Reason: exaggerated autonomic dysfunction of
cutaneous blood vessels.

14. 7.Cutis marmorata
 Benign cutaneous vascular
phenomenon seen in neonates
as an accentuated physiologic
vasomotor response to cold.
 Reticulate, bluish mottling of
skin on trunk and extremities.
 Usually disappears as the infant
is rewarmed.
 Persistence is seen in down
syndrome, trisomy 18,
hypothyroidism.

16. 8.Diaper dermatitis
 Acute inflammatory reaction of the skin
associated with wearing of napkins .
 Due to occlusive contact of urine and faeces.
 After prolonged contact , a papuloerosive
eruption occurs with formation of multiple
small ulcers called Jacquets ulcer.

17.  Management:
 Remove the contactants, keep the diaper area
dry.
 Frequent diaper change.
 Contamination by urine or feces should be
rinsed gently with warm water.
 Topical antifungal if secondary infection
present.

18.  9.Seborrheic dermatitis (Cradle crap)
 Characterised by large flakes of yellowish
scale on the scalp , may become matted into
large plaques of crust.
 Site: Scalp , face , postauricular ,presternal
and intertriginous areas.

19.  Treatment: topical weak corticosteroid-1%
hydrocortisone. Mild baby shampoo ,
ketoconazole 2% shampoo.

20. Vomiting
 Most common cause of vomiting in 1 month old
child: Aerophagy
 Other causes:
irritation of stomach by swallowed amniotic
fluid
faulty technique of feeding
gastroesophageal reflux
hypertrophic pyloric stenosis

21.  If vomiting is persistent, stomach should be
washed with 100ml normal saline and baby
offered 5% solution of glucose in water for the
next two feeds.

22. Failure to pass meconium and
urine
 All healthy babies must pass meconium within
24hrs of age.
 Initial 2-3 days : black tarry stools (meconium)
 Next 1-2 days : greenish stools (transition
stools)
 After 5 days : golden yellow stools ( mature
stools)

23.  Causes :
hypothyroidism
intestinal obstruction
hirschsprungs
disease
meconium ileus
imperforate anus

24.  Management:
Infants who breastfeed are rarely constipated.
Glycerin suppositories or rectal stimulation
with a lubricated rectal thermometer can be used
ocassionally.

25.  Fetus voids urine regularly in utero after 12
weeks of gestation.After birth most babies void
on the first day but all babies must pass urine
by 48hrs of age.
 Normal neonate voids after each feed , around
6-12 times/day.
 Stream of urine should be good and forceful.

26.  Causes
Vesicoureteral reflux
Bladder outlet obstruction –m/c form is
posterior urethral valve
Ureterocele
Spina bifida

27. Neonatal diarrhoea
 Etiology:
 Cows milk allergy
 Infections: Rotavirus, Salmonella , Shigella,
E.coli
 Antibiotic associated diarrhoea
 Glucose galactose malabsorption
 Cystic fibrosis

28.  Stool character:
1.Bloody : infections , food allergy , primary
immune deficiency
2.Steatorrhea :
exocrine pancreatic disease: cystic fibrosis
schwachman
diamond
small intestinal disease : fat malabsorption.
3.Secretory diarrhoea : hyperthyroidism ,
defective Na and Cl channels

29.  Investigations:
1.Complete blood count
2.Serum electrolytes
3.Stool testing
4.Endoscopy
5.Genetic testing

31. Reference
 Care of the newborn , Meharban Singh .
 Ghai Essential Pediatrics
 Cliical evaluation of newborns , infants and
children ,
S.Sushama Bai.

32. THANK YOU