Proteus Mirabilis

Osteomyelitis of the proximal end of the right femur with marked bony changes. Note the marked increase in the size of the hip joint. This again demonstrates that joint swelling may be the first indication of the development of osteomyelitis. The reason for the common involvement of joints in the neonatal period is that sinusoidal vessels, termed transphyseal vessels, connect the two separate circulatory systems seen in the bones of older children (the metaphyseal loops which...

Other Dermatologic Problems

The typical facies of hypohidrotic (anhidrotic) ectodermal dysplasia is seen in this infant. Note the alopecia, absent eyebrows and eyelashes, square forehead with frontal bossing, hyperpigmented wrinkles around the eyes, flattened nasal bridge, and large conspicuous nostrils. There are wide cheek bones with depressed cheeks, thick everted lips, a prominent chin, and the ears may be small and pointed. These infants have a thin dry skin, decreased sweating, decreased tearing, and...

1177

A close-up of the lesions in the lumbosacral and gluteal areas in die same infant as in Figure 1.176. Figure 1.176. The multiple pigmented nevi involving the scalp and trunk in diis infant are characteristic of the neurocutaneous melanosis sequence. There are dark pigmented multiple nevi, which are sometimes hairy and are more extensive in a bathing trunk distribution over die lower trunk, abdomen, and lower thighs. There may be leptomeningeal involvement with nests and sheets of...

Skin Lesions In The Diaper Area

Skin Lesions The Diaper Area

Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis. Figure...

1237

A close-up of cutis verticis gyrata in the same infant as in Figure 1.236. The condition is caused by an increase in dermal collagen and, as a result, excessive skin may buckle and form furrows and ridges that resemble gyri of the cerebral cortex. The condition may occur as a primary disorder without other associated abnormalities or it may be a manifestation of other padiology including Ehlers-Danlos syndrome, tuberous sclerosis, Apert's syndrome, hyperpituitarism, or...

Staphylococcus Aureus And Fertility

Staphylococcus Aureus Neck

Staphylococcal pyoderma of the neck in an infant at the age of 8 days. Figure 2.3. Bullous impetigo (pemphigus neonatorum) in a newborn infant at the age of 6 days. This infection may occur as early as the second day or as late as two weeks of life and may demonstrate bodi bullous and impetiginous lesions. It is most commonly due to a staphylococcal infection but, on occasion, is caused by Streptococcus. The lesions are more common in moist, warm areas such as the axillary folds of...

Scaling Disorders

Sclerema Neonatorum

Different abnormalities of the stratum corneum are included under the general heading ichthyosis. These conditions all involve faulty keratinization. The name is derived from the small plates of thickened epidermis yielding a pattern similar to the scales of a fish. Figure 1.215. This postmature infant is an example of a so-called collodion baby. Collodion babies are seen in postmaturity, lamellar ichthyosis, and congenital ichthyosiform erythroderma. The term collodion is used because of the...

263

Supernumerary Nipple

Desquamation on the palms and soles with no rash or desquamation elsewhere is very suggestive of congenital syphilis. The palms and soles may be fissured and erythematous and, as a result of subcutaneous edema, may have a shiny appearance. Figure 2.61. Note the desquamation of the palms and soles in a neonate. There were no other dermatologie lesions elsewhere. The VDRL Venereal Disease Research Laboratory test showed maternal blood to be reactive with a titer of 1 32 and the...

1111

Another example of a nevus anemicus present at birth on the left thigh. Capillary hemangiomas strawberry nevi may be present at birth, but generally develop during the first few postnatal weeks as pale or slightly reddened, well-demarcated zones of skin a few millimeters to several centimeters in diameter. They may occur on any area of the body but are seen most commonly on the head and neck 40 and the trunk 30 . During the first months of life, rapid growdi occurs and the lesions...

Telangiectatic Nevi Pictures

Haemangioma Salmon Patch

Macular hemangioma angel's kiss of the eyelids in a newborn infant. Vascular nevi occur in up to 40 of newborns. They are divided into three groups salmon patches, hemangiomas, and vascular malformations and are classified by their histology and the degree of involvement of the skin and subcutaneous tissues. The most common are the salmon patches macular hemangioma, nevus flammeus . They consist of dilated capillaries in the superficial layers of the dermis and are noted most...

Extra Nipples During Pregnancy

Extra Nipples

In this infant there is a unilateral supernumerary breast on the left side. Supernumerary breasts are rare. These are potentially functional and, like extra nipples, these structures occur along the embryonic milk line unilaterally or bilaterally, usually below the normal site of breast placement. The nipple and areola are quite well developed, distinguishing this anomaly from simple supernumerary nipples.

Desquamation Of Fetal Skin

Hirsutism And Pregnancy

Desquamation of the skin is a very typical finding in an abdominal pregnancy in which the fetus is not protected by the amniotic fluid. Figure 1.13. Desquamation of the skin is a very typical finding in an abdominal pregnancy in which the fetus is not protected by the amniotic fluid. Figure 1.14. Hypertrichosis hirsutism is very common in normal mature Hispanic infants. Figure 1.15. Another infant with hypertrichosis over the body at birth. Note that although this is very striking...

Dimples On Breast

Lumbosacral Area For Dimpling

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.

Supernumerary Nipple

Neonatal Supernumerary Nipple

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...

Inclusion Cyst On Baby Nipple

Cyst Baby Nipple

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...

Vestigial Tail Pictures

Vestigial 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...

Mastitis Neonatorum

Witch Milk

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...

Sclerema Neonatorum

Sclerema Neonatorum

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

Hypophosphatasia

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...

157

Fat Necrosis Newborn

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

Intrauterine Sucking Lesion

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...

Dermatology Suffusion

Photos Nuchal Cord

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

Sebaceous Gland Hyperplasia

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

Congenital Hyperthyroidism

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....

Acne Neonatal Fotos

Acne Neonatal Fotos

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

Post Term Infant Long Nail

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...

142

Postmature Infant

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

Phototherapy Rash

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

Erythema Toxicum Neonatorum

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...

Vasomotor Instability Infant

Postterm Infants

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

Postmature Baby

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

Vernix Genitals

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

Postmature Infant

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.