Dr. Mubashar Mashqoor Mir
A newborn or a neonate is a child in his first month of life. Neonates who are born through a full term normal delivery ie; 37-42 weeks of gestation require less stringent skin care that preterm newborns that are born before 37th week of gestation. Preterm newborns have immature epidermis which is responsible for an impaired skin permeability and function and thus require special skin care.
NORMAL NEWBORN SKIN
Neonates who are born at normal period of gestation are known as full term newborns and every parent and caretaker should be well versed with features of a normal newborn skin in order to differentiate it from abnormal. The skin of a full term baby is pinkish of average thickness and is free from any edema.It is neither too thin, delicate or deep red as in preterm babies nor too thick, wrinkled and pale as in post term babies.
Here are some features of a normal newborn baby which you may confuse with something abnormal.
Acrocyanosis : It is also known as peripheral cyanosis and is a normal finding is newborns in the first 48 hours of birth. It is characterised by bluish hue of the peripheral body parts like palms and soles which is especially more obvious on exposure to cold and diminishes on warming. However, if similar discolouration of the central parts like oral cavity or tongue is noticed, a doctor should be consulted.
Vernix caseosa : Commonly observed as a cheesy covering on the skin of a newborn is a normal finding and is made of secretion from the glands of the skin and skin cells. It is a nature’s way of giving protection to the delicate skin of a newborn. It protects the baby’s skin from harmful microbes and excessive water loss. Under normal circumstances it is advised to leave vernix caseosa as such at birth while wiping it off from head and neck area only.
Superficial scaling of the newborn: Many normal newborn babies may show mild superficial scaling typically around their ankles which may start from the first day of their life and may last for a few weeks .However scaling observed right at birth or too much scaling which is generalised and or associated with increased redness should be taken as a sign to visit a doctor.
Acne and acne like lesions: Neonatal acne is similar to acne (pimples) in adolescents and is caused due to hormonal effect of maternal androgens on the baby and normally resolve once the hormonal levels decline after birth. Multiple tiny yellowish papules over the nose, cheeks and chin may be due to enlargement of sebaceous glands of neonates again due to maternal hormones and are known as sebaceous hyperplasia. They disappear on their own within weeks after birth as the maternal androgen levels in the baby drop. Similar looking tiny pearly white or yellowish papules are seen over nose , cheeks , nasolabial folds etc. and are known as milia. They are also self limiting and disappear in few weeks normally.
Cutis marmorata : It is a harmless vascular phenomenon seen in newborns characterised by mesh like reticulate bluish mottling of the skin over trunk and limbs. It is more pronounced on cold exposure and resolves on warming. Persistence of this pattern for long may be abnormal and can be seen in conditions like Down’s syndrome, trisomy18 and hypothyroidism. Any abnormal pattern or persistence should be reported to a doctor.
Mongolian Spot: They are greyish blue spots of variable size usually seen over lower back, buttocks, shoulders or flanks and normally disappear after a few years. Presence of extensive lesions and persistence may be associated with metabolic and congenital disorders.
Salmon Patch: Also known as a stork mark .It presents as a pale pink coloured patch over the upper eyelid or forehead area or the nape of neck. Usually disappear by one year of birth.
Suction blisters: Few intact blisters may be seen over fingers, lips, forearm etc are due to vigorous sucking by the back when in mother’s womb. They are present over non inflamed skin and resolve on their own.
Cradle cap: Is a benign scaling of the scalp seen in infants. Gentle Oil application at night followed by rinsing and combing with a mild shampoo can help reduce the scaling.
Miscellaneous : Many other conditions like Milaria (Prickly heat) , Erythema Toxicum Neonatorum , TNPM etc. are benign and self limiting however are best differentiated and diagnosed by a dermatologist.
As a rule in all cases, self medication and unscientific practices should be avoided and whenever needed, a dermatologist’s consultation should be sought.
NORMAL NEWBORN SKINCARE
Parents should avoid using all unwanted and unscientific topical preparations to a newborn without advice of a dermatologist or paediatrician. As an antiseptic , 0.5% chlorhexidine in a non alcoholic base is considered safe in term newborns. This solution can be used to clean the umbilical cord till the cord falls off.
Bathing: WHO recommends waiting for first 6 hours of birth for routine bathing in order to avoid hypothermia and to allow positive effects of vernix caseosa.However the baby can be gently wiped with clean warm water(body temperature) at birth. In normal neonates bathing can be permitted every alternate day. Each bath should last for around 10 minutes. Liquid soap substitutes or syndet bars which are mild and have a skin friendly pH should be used. After bathing the baby should be pat dried with a soft cloth and dressed immediately.
Oiling: Oils which are rich in essential fatty acids like linoleic acid such as sunflower oil ,coconut oil etc. are useful to moisturise newborn skin and are safe to use.
Mustard Oil contains substances of antigenic character like allylisothiocynate which can cause contact dermatitis and hence is best avoided.
Powders: Powders should be normally avoided in babies unless warranted in some conditions. Occlusion of sweat pores, caking, accidental inhalation, pneumonitis etc are some potential problems associated with their use in babies.
Diapers: The author advises use of super absorbent disposable diapers. Regular change of diapers immediately after soiling is useful to prevent diaper rash. Skin should be allowed to breathe and dry between diaper changes .Cleaning of diaper area should be done with wet cotton balls or soft wet wipes. After cleaning and drying the area, an oil based water repellent cream like petrolatum or white soft paraffin should be applied before applying a fresh diaper.
Every newborn needs warm parenting and care, newborn’s skin is delicate and prone to environmental influences and thus needs regular nurturing and a watchful eye.
(The author is a Skin specialist and Cosmetologist based in Jammu and can be contacted at firstname.lastname@example.org)
Dr. Mubashar Mashqoor Mir