Atopy‐related skin rash in a normal population of infants: Distribution and rates for 50 separate skin regions: Cohort study from 4 months to 3.5 years

Analysis of the rash in a normal population of infants may give new information that is different from clinical observation of atopic dermatitis (AD). For this purpose, a cohort study was undertaken on infants at 4 months, 10 months and 3.5 years. Infants who attended the local health center for health check were the subjects. Rash related to AD, dryness, scaling, erythema, papules, exudation and crusts was recorded in 50 skin regions and divided into three degrees. Examination was performed twice a month for a year at each age. The 777 infants who attended all three examinations were analyzed in this report. Rash‐positive regions were 14.7% on average at 4 months and decreased with age. Prevalence of rash‐positive infants was 93.6% at 4 months and also decreased with age. The main findings are as follows. First, rash was more frequent and more severe in younger infants. This seems to suggest that AD in early infancy is initiated and developed by immune immaturity, and is resolved by its maturation. Second, rash involved preferentially air‐exposed and air‐closed skin in younger infants. This seems to be evidence that the epidermis of young infants is easily responsive to both dryness and wetness. Third, some regions did not show age‐dependent reduction of rash rate in younger infants. Those regions are probably irritated by saliva and urine or rubbing and scratching.     

足月儿与早产儿败血症病原菌、细胞因子及免疫功能比较

目的探讨足月儿与早产儿败血症病原茵、细胞因子及免疫功能差异。方法选取2017年1月-2019年2月在江苏省盐城市滨海县人民医院治疗的新生儿败血症患者192例,其中早产儿118例,足月儿74例,采用卡方检验和t检验比较两组病原菌、细胞因子及免疫功能差异。结果早产儿革兰阴性菌比例为25.42%,明显高于足月儿(P<0.05),而革兰阳性茵比例为71.19%,明显低于足月儿(P<0.05);早产儿降钙素原(PCT)为(1.89±0.94)ng/mL,明显低于足月儿(P<0.05),而肿瘤坏死因子-α(TNF-α)为(98.28±21.18)pg/mL,明显高于足月儿(P<0.05);早产儿免疫球蛋白G(lgG)和免疫球蛋白M(lgM)分别为(5.10±1.12)g/L和(0.17±0.08)g/L,明显低于足月儿(P<0.05)。结论足月儿与早产凡败血症病原茵、细胞因子及免疫功能有明显差异,值得进一步研究。     

Subcutaneous fat necrosis of the newborn: A retrospective study of 32 infants and care algorithm

Objective

To describe the clinical and laboratory outcomes of infants with subcutaneous fat necrosis of the newborn (SCFN) and propose a care algorithm.

Methods

This single-center, retrospective study of infants diagnosed with SCFN at Ann & Robert H. Lurie Children's Hospital of Chicago from 2009 to 2019.

Results

Of 32 infants who met inclusion criteria, most were born full-term (84%), born via cesarean section (58%), had normal weight for gestational age (69%), and experienced delivery complications (53%). Twenty-nine infants (91%) had calcium drawn, and all had hypercalcemia. Three infants developed clinical symptoms of hypercalcemia, two required hospital admission, two developed nephrocalcinosis, and one developed acute kidney injury. The majority of infants (62%) had a peak ionized calcium between 1.5 and 1.6 mmol/L. No infants with peak ionized calcium less than 1.5 mmol/L developed complications of hypercalcemia. Most patients were diagnosed with hypercalcemia (86%) and demonstrated peak ionized calcium levels (59%) within the first 28 days of life. No patients developed hypercalcemia after 3 months of age.

Conclusion

Hypercalcemia occurred in 100% of infants who had laboratory monitoring. We recommend obtaining an initial ionized calcium level when SCFN is suspected, and monitoring for the first 3 months of life if hypercalcemia has not been detected. In patients with asymptomatic hypercalcemia less than 1.5 mmol/L, there appears to be low likelihood of related complications. For symptomatic, markedly elevated (>1.6 mmol/L), or persistently elevated levels (>6 months) we suggest coordinated care with endocrinology or nephrology, consider hospitalization, and urinary system ultrasound.     

Recurrent Oral and Genital Ulcers in an Infant: Neonatal Presentation of Pediatric Behçet Disease

Behçet disease is a complex, multisystem disease characterized by recurrent oral and genital ulcerations. It rarely occurs in infants or children. Neonatal Behçet disease has been reported in infants whose ulcers resolve at or before 9 weeks of age. Few cases of neonatal Behçet disease persisting into childhood have previously been reported. We report the case of a 1‐month‐old infant who presented with severe recurrent genital ulcerations and at 6 months developed recurrent oral ulcerations. Her orogenital ulcerations continue to recur. Human leukocyte antigen testing revealed HLA‐B51 and B44 positivity. This is a case of pediatric Behçet disease in the neonatal period. Behçet disease should be considered in the differential diagnosis of recurrent genital and oral ulcerations in infants and children.     

Loss of cutaneous microbial diversity during first 3 weeks of life in very low birthweight infants

Neonatal sepsis (NS) is a frequent problem in neonatal intensive care, especially in preterm and very low birthweight (VLBW) infants. The objective of the study was to characterize the cutaneous bacterial microbiome in VLBW infants treated in the neonatal intensive care unit (NICU). Non‐invasive skin microbiome specimens were taken repeatedly from 12 VLBW infants during treatment in NICU starting on the first day of life. All infants received benzylpenicillin and netilmicin during the first 1‐5 postnatal days. Samples were also collected from incubators. High cutaneous microbial diversity was present at birth in 11 of 12 of the infants, but the diversity decreased substantially after the first weeks of life in all infants regardless of their infection status. After the loss of diversity, one Staphylococcus operational taxonomic unit dominated the skin microbiome. Recovery of microbial diversity was seen in six of 12 neonates. The microbiome of incubators showed typical environmental bacterial genera. Maternal antibiotic treatment, the aetiology of the preterm birth or being born by C‐section did not appear to affect the diversity of skin microbiota at birth, and no correlation was found between cutaneous microbiome and NS.     

SKIN FLORA OF INFANTS WITH NAPKIN RASH

SUMMARY.— Qualitative and quantitative studies of the skin flora of the buttocks were carried out on a group of 60 infants attending a Family Health Clinic. No significant differences were found between the bacterial flora of infants with napkin rash and of normal subjects. In 2 babies with napkin eruption small amounts of Candida Albicans were grown, but these were considered to be of no clinical significance.
These results contrast with a high incidence of yeasts in some other studies. The discrepancy is explained by the selection of the groups of infants and by geographical and climatic factors.
A definite clinical pattern can be followed in early cases of napkin eruption in male and female infants.     

Functional skin adaptation in infancy – almost complete but not fully competent

Please cite this paper as: Functional skin adaptation in infancy – almost complete but not fully competent. Experimental Dermatology 2010; 19: 483–492. Abstract: Early postnatal life is a period of active functional reorganization and cutaneous physiological adaptation to the extrauterine environment. Skin as the outermost organ of mammalians is endowed of multiple functions such as protection, secretion, absorption and thermoregulation. Birth stimulates the epidermal barrier maturation and the skin surface acidification especially in premature infants. In full‐term infants the developed stratum corneum accomplishes competent barrier function, in contrast to prematures. Complete barrier maturation in preterm infants is fulfilled by 2–4 weeks of the postnatal life. However, in preterms with 23–25 weeks gestational age this process takes longer. Versatile regulatory mechanisms, namely skin surface acidity, calcium ion gradient and nuclear hormone receptors/ligands are interrelated in the complex postnatal newborn adaptation. The skin of newborns is adjusting quickly to the challenging environmental conditions of the postpartum. However, certain functions, for example, microcirculation, continue to develop even beyond the neonatal period, that is, up to the age of 14–17 weeks. Different environmental factors (for instance, dry and cold climate, diapers and cosmetic care procedures) influence the postnatal development of skin functional parameters such as stratum corneum hydration and the permeability barrier especially in premature infants. The aim of this article is to summarize the current knowledge on skin physiology in newborn and infants with a practical approach and to discuss the possible clinical consequences. This review offers the readership a critical and practical overview of skin physiology in newborns and infants. It emphasizes possible new research fields in neonatal and infantile skin physiology.     

Relationship Between Skin Barrier Function in Early Neonates and Diaper Dermatitis During the First Month of Life: A Prospective Observational Study

Diaper dermatitis, a common skin problem in newborn infants, is characterized by poor functioning of the skin barrier. This study aimed to elucidate the relationship between skin barrier function in 4‐day‐old infants and the occurrence of diaper dermatitis during the first month of life. We recruited healthy Japanese infants born at 35 weeks of gestation or more. We measured indicators of skin barrier function, namely skin pH and transepidermal water loss, in 4‐day‐old infants on four places on the body. Individual characteristics were recorded from the infants' medical charts. The presence of diaper dermatitis was judged using the diaper rash and erythema scoring scale, which was based on daily recording of the infants' skin condition by their parents. The parents also filled out a questionnaire 1 month after birth regarding stool frequency and certain external factors. The association between diaper dermatitis and skin barrier function was assessed using multiple logistic regression analysis. The analysis included 88 infants. The incidence of diaper dermatitis was 25.0%. After adjusting for stool frequency for 1 month we noted that high pH on the inner arm skin in 4‐day‐old infants increased the risk of diaper dermatitis during the first month of life (adjusted odds ratio 3.35 [95% confidence interval = 1.12, 10.04]). Early neonatal skin pH may predict the risk of diaper dermatitis during the first month of life. Our results may be useful in devising strategies to prevent diaper dermatitis.     

Serum estradiol levels in infants with and without labial adhesions: the role of estrogen in the etiology and treatment

Abstract:  No strong evidence has been found that estrogen levels in girls with labial adhesions are lower than in girls without. Therefore, this study was based on the determination of estradiol levels in girls with and without labial adhesions in order to show whether a considerable difference exists between these two groups. Serum estradiol levels were measured in 59 infants with labial adhesions and in 60 healthy infants. No significant age difference was seen between affected infants and controls, with a mean age of 12.7 and 12.4 months, respectively. Serum estradiol levels ranged from 6.5 to 14.3 pg/ml (10.27 ± 1.897) in those with labial adhesions and from 6.4 to 15.1 pg/ml (10.47 ± 2.006) in controls, a statistically insignificant difference (p = 0.5764). When taking into consideration the effect of estrogen on wound healing and the fact that the difference in estrogen levels between the infants with and without labial adhesion is not significant, it is concluded that hypoestrogenism does not take place in the development of labial adhesions, but that creams containing estrogen might have a beneficial effect on healing after mechanical separation of the adhesion by enhancing wound reepithelialization.     

Nail alterations in 250 infant patients: a clinical study

Aims To investigate the frequency and the nature of nail alterations in infants. Study design A total of 250 infant patients from newborn to 2 years of age were evaluated from the outpatient clinics of paediatrics and dermatology departments, Fatih University Hospital. The nail alterations were documented. The data were presented as percentages, and for categorical comparisons, Chi‐squared or Fisher's Exact test were used. P < 0.05 was considered statistically significant. Results Of the 250 infant patients, nail alterations were seen in only 17 (6.8%). Most of the patients had toe nail involvement. In 12 of 17 (70.6%) infants, there was one type of nail alteration; in 4 of 17 (23.5%) infants, there was two type of nail alterations; and in 1 of 17 (5.9%) infants, there was three type of nail alterations. The most frequent diagnosis was onychoschizia in 6 of 17 (2.4%) and congenital hypertrophy of the lateral nail fold together with ingrown nail in 6 (2.4%) infants. Conclusion Because nail alterations could be a manifestation of systemic or dermatologic diseases in infants, fingernail and toenail examination should be a part of the paediatric dermatology examination.     

Neonatal lupus erythematosus: a review of the racial differences and similarities in clinical, serological and immunogenetic features of Japanese versus Caucasian patients

There has been tremendous interest in neonatal lupus erythematosus (NLE) since the reports of anti‐Ro/SSA antibodies as a diagnostic marker. Recent studies, including ours, have revealed racial differences as well as similarities in the clinical features and immunogenetic backgrounds of Japanese and Caucasian patients with NLE. The frequency of photosensitivity and subacute cutaneous LE lesions is not high in Japanese infants with NLE, which is in sharp contrast to their Caucasian American counterparts. The majority of Japanese infants with NLE develop annular, erythematous or edematous lesions which have also been reported in association with Sjögren's syndrome. The frequency of isolated congenital heart block (CHB) is about 50% in Japanese anti‐Ro/SSA positive neonatal lupus infants; this is similar to the frequency among Caucasians. The HLA‐DR3 phenotype, which is found in the great majority of Caucasian mothers of NLE infants, is absent in Japanese mothers. Finally, both Japanese and Caucasian children with CHB are often identical to their mothers in their alleles of HLA‐DRB1, DQA1 and DQB1 loci.     

The fetal prognosis in pemphigoid gestationis (herpes gestationis)

We have studied the infants in fifty pregancies affected by pemphigoid gestationis (herpes gestationis). There was a significant increase in the frequency of infants that were ‘small for dates'. As such infants have a raised mortality and morbidity it follows that in pemphigoid gestationis the fetal prognosis is impaired. In view of this it is essential that patients with pemphigoid gestationis are delivered in maternity units which have facilities for intensive care of the newborn. There has long been uncertainty over the fetal prognosis in pemphigoid gestationis (PG) (formerly called herpes gestationis) and this has not been dispelled by two recent studies. A literature review of immunofluorescence positive cases indicated that the risk to the fetus was substantial (Lawley, Stingl & Katz, 1978) while a further report found no evidence of increased morbidity or mortality (Shornick et al., 1983). The inconsitency of these studies may stem from the fact that their conclusion were based solely on the fetal outcome which could have varied with the standard of obstetric and perinatal care. A fundamental method of assessing fetal risk is to simply measure the infant weight and compare it with the weight expected for the gestation. This information has not been recorded in previous studies of PG. In our patients documentation of the infants’weights and gestations and calculation of the incidence of ‘small for dates’infants has enabled us to clearly define the fetal risk in PG.     

Application of a photoelectric magnifier to nasal injury in preterm infants receiving non-invasive ventilation: A prospective observational study

PurposeThis study was to explore a photoelectric magnifier assessing nasal injury in preterm infants receiving non-invasive ventilation (NIV) treatment, and to describe the occurrence status and risk factors of nasal injuries.DesignA prospective observational study.Subjectsand setting: Preterm infants admitted from the Second Affiliated Hospital of Wenzhou Medical University between October 2018 and October 2019.MethodsA continuously convenient sample of 127 preterm infants was included. When the infants were receiving NIV treatment, nursing staff checked nasal skin and mucosa daily with a photoelectric magnifier to confirm whether nasal injuries occurred. Meanwhile, a self-designed questionnaire was used to collect data. The Chi-square test, t-test, univariate and multiple logistic regression model were applied.ResultsA total of 127 preterm infants received 175 times NIV therapy, showing that the incidence of nasal injuries (infants number) was 27.6% (35/127) and the incidence of nasal injuries (ventilation cases) was 21.1% (37/175). Of the 37 cases of nasal injuries, 27 cases were I stage, while Ⅱ stage, Ⅲ stage and mucosa injuries appeared 2 cases, 2 cases and 6 cases. In the multivariate logistic analysis, nasal mask interface and NIV treatment more than seven days were independent risk factors affecting the occurrence of nasal injuries.ConclusionsThe premature infants who received nasal NIV treatment were susceptible to nasal injuries, and clinical nurse capable of identifying risk factors and inintervening should be strengthened to prevent the occurrence and progression.     

Herpes simplex virus infections in the newborn

Neonatal infection caused by herpes simplex virus (HSV) is a serious disease associated with high morbidity and mortality. The precise incidence of neonatal herpes is not known because the disease is not subject to mandatory reporting, but estimates range from 1 per 3500 to 1 per 20,000 live births.¹ With the dramatic increase in incidence of genital herpes in the United States it is possible that the frequency of herpes neonatorum will show a corresponding rise. Newborns infected with HSV who do not receive antiviral therapy may have a fatality rate as high as 80%.² The small percentage of infants who survive the infection generally have severe neurologic sequelae. With the development of effective antiherpes agents it is anticipated that both the mortality and the morbidity will be significantly reduced in infants who are identified early and treated promptly.In contrast to cytomegalovirus, HSV very rarely crosses the placenta to cause an infection in utero. The vast majority of HSV-infected infants acquire the virus during the birth process.³ This means that the infected infant who is identified soon after delivery has the greatest likelihood of a favorable outcome. The first sign of infection in most infants is characteristic skin vesicles, which should be an indication for immediate antiviral therapy. The objective of this report is to review the current state of epidemiology, pathogenesis, diagnosis, and management of neonatal herpes infections.     

Effect of a synthetic detergent (Syndet) on the pH of the skin of infants

The long- and short-term effects on the skin of infants of a synthetic detergent (syndet) with an acid pH were investigated and compared to ordinary soap. The short-term effect was determined by measuring the skin pH on different parts of the body before and 20 min after washing with syndet. The long-term effect was tested in a second group, in which the infants were washed either with ordinary soap or with syndet for 3 days. The skin pH was measured 4-5 h after washing. The results were evaluated statistically. The results show that for a short time syndet displaces the skin pH towards acid pH in younger infants; however, the skin pH is not influenced in older infants. Syndet keeps the skin pH in the physiological range for a longer time after washing than ordinary soap.     

Changes to infant feeding guidelines: Relevance to dermatologists

The newly revised Australian Infant Feeding Guidelines recommends that all infants, including those at high risk of allergy, be introduced foods traditionally considered allergenic (such as peanut butter, dairy, wheat and egg) within the first year of life. High‐risk infants are those with early onset eczema (<3‐months old) or with moderate to severe eczema not responding to treatment (<6‐months old). Eczema can also represent a symptom of allergy presentation and the recommended introduction of some foods in this group may lead to allergic reactions at home. Although there have been no reported deaths from gradual food introduction to infants at home and cohort studies have only reported mild to moderate reactions, there is anecdotal evidence that more severe reactions can occur rarely. Allergic reactions, even if they are not life‐threatening, can be a terrifying experience for parents. Dermatologists play an important role when dealing with high‐risk infants in promoting the message of early allergenic food introduction yet also instigating appropriate allergy testing when necessary. This short review aims to provide an update to Australasian dermatologists on the newly revised Australian Infant Feeding Guidelines and provide a food allergy screening pathway for high‐risk infants prior to commencement of allergenic foods.     

Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life

Skin water barrier development begins in utero and is believed to be complete by week 34 of gestational age. The goal of this investigation was to assess the dynamic transport and distribution of water of the stratum corneum of infants and compare it to those of adults. The interaction of water with the stratum corneum was assessed by measuring capacitance, transepidermal water loss (TEWL), rates of absorption-desorption as well as Raman spectra as a function of depth (a total of 124 infants (3-12 months) and 104 adults (14-73 years)). The results show that capacitance, TEWL, and absorption-desorption rates had larger values consistently for infant stratum corneum throughout the first year of life and showed greater variation than those of adults. The Raman spectra analyzed for water and for the components of natural moisturizing factor (NMF) showed the distribution of water to be higher and have a steeper gradient in infants than in adults; the concentration of NMF was significantly lower in infants. The results suggest that although the stratum corneum of infants may appear intact shortly after birth (<1 month), the way it stores and transports water becomes adult-like only after the first year of life.     

Comparison of the Effect of Human Milk and Topical Hydrocortisone 1% on Diaper Dermatitis

Diaper dermatitis is one of the most common skin problems in infants and children, affecting between 7% and 35% of infants. This randomized clinical trial compared the efficacy of hydrocortisone 1% ointment with that of human breast milk in treating acute diaper dermatitis in infants ages 0 to 24 months. Infants with diaper rash were treated with either hydrocortisone 1% ointment (n = 70) or human breast milk (n = 71) for 7 days. Improvement in the rash from baseline was seen in both treatment groups on days 3 and 7; there was no significant difference in total rash scores on days 3 and 7. Treatment with human breast milk was as effective as hydrocortisone 1% ointment alone. Human breast milk is an effective and safe treatment for diaper dermatitis in infants.     

THE INCIDENCE OF BIRTHMARKS IN ISRAELI NEONATES

Background. Several studies have documented cutaneous findings in neonates of various racial groups. Our purpose was to determine the frequency of birthmarks in Israeli neonates of Jewish and Arabic origin. Methods. A cohort of 1672 newborn infants under 96 hours of age were examined for the presence of birthmarks. Of these 841 (50·3%) were Jewish and 831 (49·7%) were Arab. The Jewish group was further subdivided into various ethnic groups according to parental ancestry. Results. Melanocytic brown lesions (Mongolian spots, congenital nevi, and cafe-au-lait spots), were more common in Arab infants. The vast majority of Jewish infants with Mongolian spots were of Asian or African ancestry. On the other hand, congenital melanocytic nevi were found only in Jewish infants of European ancestry. Vascular lesions (salmon patch and port-wine stain) in Arab neonates exhibited a female preponderance. Conclusions. Our data suggest that the prevalence of birthmarks in Israeli neonates is similar to the prevalence reported by others in white neonates.