Common skin complaints in neonates
A number of skin problems may present in the neonatal period. Some are minor but may still cause concern for parents, while others may require treatment, specialist advice, investigation and/or continued observation. It is important for midwives to be able to recognise common skin problems and know when to refer the family for further advice or treatment.
Alongside the midwife's role in antenatal care and during birth, responsibilities extend to some care of the newborn in the first few weeks of life, during which time a variety of skin problems may present. At this stage of the neonatal period, the skin has not fully matured and may be particularly vulnerable. It is important to understand the structure of neonatal skin and how the risk of complications may be reduced, and to recognise changes that will resolve spontaneously or with simple intervention, as well as those problems that require specialist supervision and advice. This article considers some common skin conditions that may occur in the neonatal period.
The thickness of the stratum corneum, the outer layer of the skin, plays an important part in its barrier function, where it helps to regulate the body's fluid and electrolyte balance, maintain temperature and reduce absorption and resulting toxicity of topical medications or other substances applied to the skin. The stratum corneum varies in thickness depending on age; in a term infant it is 30% that of an adult, and even thinner in a preterm infant, causing the skin to be more permeable and at risk of dryness (Crozier and Macdonald, 2010). Another factor in vulnerability is related to colonisation of the skin that protects against harmful bacteria. Skin is alkaline at birth but, within about 4 days, it becomes acidic and more protective against bacteria; however, the acidity may be delayed in preterm infants and thus less protective against bacterial infection (Jackson, 2008). In the last trimester of pregnancy, fetal skin is protected by the amniotic fluid and vernix, which is made up of sloughed cells from the stratum corneum; it helps early acidification as well as acting as a natural cleanser, moisturiser, anti-infective and antioxidant, and aids wound healing (Jackson, 2008).
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