Common Physiologic Problems In The Newborn

Introduction

Neonates are unique in nature and often manifest certain physiologic features that are normal but can be a cause of concern for the parents. These conditions have to be diagnosed appropriately to avoid unnecessary treatment. At the same time, parents have to be counseled about the natural history of the condition to allay anxiety.

Caput succedaneum

Caput is a soft tissue swelling due to edema in the subcutaneous tissue of the scalp in the presenting part of the head during delivery. It usually extends across the midline and does not have a well-defined margin and is often pitting and not fluctuant, unlike cephalhematoma. It is present at birth and disappears in the first week of life. Usually, it does not require any treatment. Rarely there can be hemorrhagic caput presenting with features of shock.

Subconjunctival hemorrhage

Subconjunctival hemorrhages are common in following normal vaginal and instrumental deliveries. They are often associated with retinal hemorrhage. They usually subside in 1-2 weeks.

Stork bites/Salmon patch

Stork bites are pink to red patches seen in upper eyelids and forehead in newborn infants. They are due to dilated capillaries in the skin. They usually subside in a month.

Milia/Epstein pearls

Milia are white epidermal inclusion cysts containing keratin. Milia occurring in palate and buccal area are called Epstein pearls. It also occurs in prepuce of the penis commonly. They usually disappear in few weeks and do not require any treatment.

Sebaceous hyperplasia

Minute yellow white papules in forehead, nose and cheeks of term infants usually. They are due to hyperplastic sebaceous glands and they disappear in the first few weeks.

Natal teeth

Natal teeth are present at birth. Unlike regular teeth they are poorly formed and are mobile. They can cause ulceration of tongue and interfere with feeding. They may get dislodged and get aspirated. They have to be removed if they are mobile after consultation with a dentist.

Oral thrush

Oral thrush is a fungal infection caused by Candida albicans. It is a benign condition and usually responds well to topical clotrimazole. Usually the mother also can have candida infection in nipple or areola and has to be treated. However recurrent infection with failure to thrive and diarrhea may suggest the possibility of immunodeficiency and has to be evaluated for the same.

Breast enlargement

Breast enlargement can occur in both male and female neonates often with milk secretion under the influence of maternal estrogens. It occurs in first week and resolves usually by second week. Parents and care givers should be advised not to express milk as it can result in mastitis.

Umbilical discharge

Serosanguinous umbilical discharge is normal after separation of the umbilical cord. It also occurs due to umbilical granuloma- a pink friable tissue in the base of the umbilicus. It usually requires salt application. Sometimes may require cauterisation with copper sulphate or silver nitrate.

However purulent discharge from the umbilicus can be due to umbilical sepsis and may require systemic antibiotic therapy.

Rarely discharge from umbilicus may be due to polyps from remnants of the vitello-intestinal duct or urachal remnants. Patent urachus can cause urinary discharge from the bladder through umbilicus.

Umbilical hernia

Umbilical hernia is due to defect in the anterior abdominal wall overlying umbilicus. They close spontaneously by one year of age and majority by 4-5 years of age. Parents should be reassured and should be advised to seek medical attention if the contents of the sac cannot be reduced.

Erythema toxicum

It is a self limited rash which may be macular to popular or pustular surrounded by erythema. It occurs over trunk, face and limbs. Palms and soles are usually spared. It occurs on day two and usually disappears in first week. It is due to collection of eosinophils in epidermis.

Mongolian spots

Mongolian spots are bluish green macules which most commonly in lower back, posterior thigh and legs and rarely in other areas. These spots are due to dermal location of melanocytes due to arrest of migration of melanocytes from neural crest to epidermis. These spots usually disappear in the first year of life.

Vaginal bleeding

Vaginal bleeding or pseudo menses is common in female babies and is a cause of concern for the parents. It is due to withdrawal of maternal estrogens. It usually starts 2-3 days after birth and subsides within a week. If bleeding persists beyond one week or its profuse coagulopathy has to be ruled out and vitamin K if not administered at birth should be administered.

Hiccups

Hiccups during feeding is common in newborn babies and is due to irritation of diaphragm due to rapid distension of stomach or swallowing of air during feeding. Interruption of feeding and burping the infant may relieve hiccough. Parents should not be advised to feed more and should be discouraged from giving other liquids such as water to relieve hiccough.

Sneezing

Sneezing is common in neonates. Only if sneezing is accompanied by nasal discharge or cough it could indicates upper respiratory tract infection. Sneezing associated with nasal block may require saline nasal drops to relieve nasal block especially before feeding.

Watering from eyes

Neonates do not shed tears. However watering from eyes can occur due to block in the lacrimal duct. Parents should be asked to do compression in the lacrimal sac area regularly to relieve the block. If the watering does not improve consultation with pediatric ophthalmologist is required.

Cradle cap

Cradle cap or seborrheic dermatitis is common in infants and results in formation of greasy scales in the scalp. This is often attributed to superficial fungal infection. It is self-limiting and requires only application of oil and removal of scales. However if it a cause of concern for parents shampoo containing ketoconazole or selenium sulphide can be used regularly.