Common Newborn Problems Ralph Vogel, RN, PhD

Miliaria Fine white rash of face resembles acne. Usually not in any other place No drainage or general redness Self limiting. May be from maternal hormones Usually no itching or discomfort in miliaria crystallina, in older children is heat rash and called miliaria rubra.

Neonatal Infectiosum Acne type rash of newborn that is angry looking and covers all or part of face. Major concern to mothers Due to hormones from mother Should not use steroids or any medication Self limiting and not an infection although can look like pus.

Cradle Cap White flaky condition of scalp Form of dandruff but may be more pronounced May be mistaken for tinea capitas Usually baby shampoo and brushing with soft brush will improve. Do not use medication or dandruff shampoo, baby oil may be OK

Thrush Caused by lack of immune systems ability to control candida. White irregular patches in mouth on mucous membranes Often have candida diaper derm also. Oral thrush treated with nystatin susp qid for 2 weeks

Diaper Derm - Candida Most common cause is candida with inflamed areas with white cheesy areas. Especially seen in skin folds. Caused by heat and moisture May itch, have odor and very irritating. Burns when exposed to urine Treatment is to keep dry and open to air and nystatin cream, sometimes 1% HC

Diaper Derm - other May become infected with staph or other fungus. Angry with pus that is white, yellow or green. May cause fever in infant Use topical or systemic antibiotics depending on severity. Key is early diagnosis

Neonatal Jaundice Jaundice is a common problem Generally can be distinguished by timeline and presentation a.Within first 24 hours. Most serious and may indicate major liver problem or failure. b.Physiologic jaundice. Occurs after 24 hours and may progress. c.Breast feeding jaundice occurs after a week of breast feeding

Hypoglycemia Usually seen in first 24 hours with blood sugar below 40 mg/dl Usually stabilizes, if continues then consider more serious problem. Common causes are usually infant of a diabetic mother (IDM) or Intrauterine Growth Restriction. May also occur with sepsis or hypoxia

Respiratory Distress May have multiple reasons If occurring after one week consider GERD, Tracheal Esophogeal fistula, RSV or other infection. Any pulse ox below 92% is worrisome in a newborn or any infant Listen carefully for equal breath sounds to be sure not a pneumothorax

Heart Murmurs From 50 – 90% of children will develop heart murmur. Grade I or II most likely innocent Diastolic murmurs should always be considered pathologic unless proven otherwise. Check blood pressure both arms and history of distress

Brachial Plexus Injury Unable to move arm. Arm adducted, internally rotated, extended and pronated at the elbow. Caused by injury to C5-C6 area. Function often returns over several weeks.

Drug Exposure Cocaine is most commonly abused drug by mother, 20-40% in some urban clinics. Difficult to assign specific injuries to one drug since users often use multiple. Assess for FTT, hyperactivity, irritability, vomiting, diarrhea, seizures, nasal stuffiness, respiratory distress, lack of bonding.

Congenital anomolies Extra digits. May tie off or remove soon after birth Ear changes. May have flaps or tags which are harmless. But look for low set ears or any major abnormalities which indicate other anomoly. When you have three or more abnormalities think syndrome

Birthmarks Strawberry hemangioma – red, raised mass that can be small or cover extensive areas. Mass of convoluted vessels. Very vascular and high risk surgery. Mostly problematic on face or if obstructing breathing. Portwine stain – reddish flat birthmark usually on face. Superficial but disfiguring.

Birthmarks Salmon patch (storkbeak mark). Reddish discoloration on neck where stork held baby. May be permanent but covered by hair. Pyogenic Granuloma. Similar to hemangioma but these are reaction to some irritant. Benign tumor.

Nevi/melanoma Nevi are raised brown or black small masses or large areas that are generally benign but may become malignant. Melanoma is a malignancy that does pass through placenta. Melanomas are dark, irregular raised masses that may have hair in them

Case Study Mother brings 7 day old to clinic with history of 3 days of jaundice that is progressing. Infant is breast fed and has not had problem. What do you want to do?

Case Study Mother bring 3 week old to clinic with reported “fever” and felt hot last night. Sister has respiratory illness and has been febrile for 2 days. Infant has eaten well and seems normal on exam. Mother gave Motrin ¼ tsp last night but no meds this morning. VS. T 99.3 R 42 P 110

Case Study Jason is a 4 month old that mother brings to clinic a week after well child appointment because he is spitting up. Ht. is 50%, HC 50%, Wt 90% He has not received 4 month immun. She has introduced fruit, vegetables and meat baby foods and gives potatoes from her plate.