2012.3-4.clinical spectrum

DOI: 10.7241/ourd.20123.40                                                                                   article in PDF
Our Dermatol Online. 2012; 3(3): 178-180 
Date of submission: 04.03.2012 / acceptance: 03.04.2012 
Conflicts of interest: None

CLINICAL SPECTRUM OF NEONATAL SKIN DISORDERS AT HAMDARD UNIVERSITY HOSPITAL KARACHI, PAKISTAN
KLINICZNE SPEKTRUM SKÓRY NOWORODKÓW W SZPITALU UNIWERSYTECKIM HAMDARD W KARACHI, PAKISTAN

Muhammad Javed

Department of Pediatrics, Hamdard University Hospital, M.A. Jinnah Road, Karachi, Pakistan

Corresponding author: Dr. Muhammad Javed       drjaveddow75@hotmail.com


 

Abstract
Objective: To analyze the clinical spectrum of skin conditions in neonates at Hamdard university hospital. Study Design: Descriptive (Observational) cross sectional study.
Methods: This study was conducted from January 2008 to December 2009. All neonates seen at Hamdard university hospital during this period were examined. Neonates with skin conditions with in 28 days of birth were registered on a predesigned questioner by the house officer these cases were confirmed by the pediatric consultant, followed by detail physical systemic examination and skin examination. Dermatologist was involved in the diagnosis of difficult cases.
Results: Total numbers of new born seen during the year 2008- 2009 were 1660, there were 65% males and 35% females, 1360 (81.92%) were above 2.5 Kg at birth, 18.08% were below 2.5 Kg. Numbers of neonates with skin lesions were 577 (34.75%). Neonates with skin infections were 25.12%, 15.59% had with nappy rash and 15.59 % had erythema toxicum neonatrum. Neonates with milia were 60 (10.39%) and with erythema were 27 (4.67%).
Conclusion: Clinical spectrums of neonatal skin are different in this study as compared to other regional and international studies.
 
Streszczenie
Cel: Analiza kliniczna spektrum chorób skóry u noworodków w szpitalu Uniiwersyteckim Hamdard. Projekt badania: Opisowy (obserwacyjny) przekrój badania.
Metody: Badanie zostało przeprowadzone w okresie od stycznia 2008 do grudnia 2009 roku. W tym okresie zbadano wszystkie noworodki widziane w szpitalu uniwersyteckim Hamdard. Noworodki z chorobami skóry w 28 dni od urodzenia były zarejestrowane na gotowych kwestionariuszach przez lekarza rezydenta, następnie te przypadki zostały potwierdzone przez konsultanta dziecięcego, po szczegółowym systemowym badaniu fizykalnym i badaniu skóry. Dermatolog był zaangażowany w diagnostyce trudnych przypadków.
Wyniki: Całkowita liczba noworodków obserwowana w latach 2008 – 2009 wynosiła 1660, w tym 65% płci męskiej i 35% płci żeńskiej, 1360 dzieci (81,92%) było powyżej 2,5 kg po urodzeniu, 18,08% było poniżej 2,5 kg. Liczba noworodków z zmianami skórnymi wynosiła 577 (34,75%). Noworodków z zakażeniami skóry było 25,12%, 15,59% miało pieluszkowe zapalenie skóry a u 15,59% stwierdzono toksyczny rumień noworodków. Noworodków z prosakami było 60 (10,39%) a z rumieniem 27 (4,67%).
Podsumowanie: Kliniczne spektrum skóry noworodków w tym badaniu różni się w porównaniu do innych badań regionalnych i międzynarodowych.
 
Key words: newborn; dermatology; dermatose
Słowa klucze: noworodek; dermatologia; dermatozy

 

Introduction
Children suffer from different dermatological conditions than adults.nbsp;Neonates form special group, the skin of the infant differs from that of the adult, in that it is thinner, delicate, has weaker intercellular attachments and produces fewer sweat and sebaceous gland secretions and is more susceptible to several infections [1]. Pediatric dermatological conditions accounted for large number of referrals [2].

Material and Methods
This study was carried out at Hamdard university hospital, an undergraduate teaching hospital. All neonates born at hospital during Jan 2008 to Dec 2009 were included in the study, critically sick neonates on ventilator were not included in the study, a detailed history of the neonates’ age . sex, maturity, birth weight, significant maternal history and mode of delivery was elicited. and a pretested questionnaire was used, data was collected by the house officer department of pediatrics, diagnosis was confirmed by consultant, difficult cases were discussed by the dermatologist and diagnosis confirmed by detail physical systemic examination and skin examination. SPSS 15 was used to determine frequencies and endnote for writing references.
Limitation of study:
Sort duration of study two year, small number of cases, relation of skin lesions to preterm, term, post term neonates, and low birth weight / normal weight neonate was not studied.
 
Results
Total numbers of new born during the year 2008- 2009 were 1660 newborns. Total numbers of male children were 1078 (65%), female neonates were 582 (35%). Total numbers of children above 2.5 Kg birth weight were 1360 (81.92%). Number of low birth weight were 300 (18.08%). 442 mothers were between the ages of 19 years to 30 years. (76.62%) 358 mothers delivered vaginally (62%) 219 mothers had instrumental delivery (38%) 352 mothers were given antibiotics 24 hours prior to delivery due to various reasons (61%). Total numbers of neonates with skin lesions were 577 (34.75%) (Tabl I). Numbers of neonates with skin infections were 145 (25.12%). neonates with nappy rash were 90 cases (16.0%). There were 120 cases of Mongolian spots (21%) 90 cases of erythema toxicum neonatrum were present in this study (16%) neonates with nappy rash were 90 (16.0%). Numbers of neonates with milia were 59 (10.22%), numbers of cases with erythema were 27 (4.67%), there were 25 cases of neonatal acne (4.33%) there were 10 cases of haemangioma (1.73% ) there were 2 cases of café-eu-lail, seborrheic dermatitis, collodian baby one case of harlequin fetus, Epidermolysis bullosa, Sucking blister Scalded Skin Syndrome, Neonatal pustular melanosis.
 
 
Sr No
 Type
Number of cases
Infections 145 25,12%
Mongolian spots 120 20,79%
Transient toxic erythemia 90 15,59%
Nappy rash 90 15,59%
Milia 59 10,22%
Erythema 27 4,67%
Neonatal acne 25 4,33%
Hamangioma 10 1,73%
Café- eu-lail 2 0,34%
Seborrheic Dermatitis 2 0.34 %
Collodian baby 2 0.34 %
Epidermolysis bullosa 1 0,17%
Sucking blister 1 0,17%
Scalded Skin Syndrome 1 0,17%
Neonatal pustular melanosis 1 0,17%
Harlequin fetus 1 0,17%
Total 1 0,17%

Table I. General distribution of skin conditions

 

Discussion
Neonates skin condition deserve special attention in hot humid, subtropical climate of Karachi, there is limited data on neonatal dermatology in Pakistan. Five year study by Maqbool S. Razzak S. [3] and Zahoorullaha [4] on skin disorders in children, there is no case report of neonatal skin lesion. Benton EC [5] has not reported a single case of neonatal dermatitis during 25 years of their study period. Some international studies have mainly focused on benign cutaneous lesions in newborns [6,7]. 34.75% neonates had skin manifestations during the study period, reported incidence is 27.6% to 31% [8,9]. Maximum numbers of cases in this study were due to Skin infections (25.12%) this is particularly important because our neonates are over covered, in hot humid, subtropical climate. Reported incidence is between 5% to 47.15% [10-11]. There were 21% neonates with Mongolian spots, mainly on buttocks in this study; reported incidence is 56% to 98% [13- 14]. There were 15.59% with nappy rash in this study; Ferahbas A et al [14] reported incidence of 2% this difference may be due to financial reasons, our mothers do not change nappies as frequently as required leading to prolong stool contact resulting in nappy rash. Erythema toxicum neonatrum is the most common pustular dermatitis in newborns a benign condition requiring no intervention, presented in 15.50% of neonates in this study, reported incidence is 21-40% [15,16]. There were 10.22% neonates with milia in this study; reported incidence is 40-50% in other studies [17]. There were 4.33% reported incidence is 40% – 50% in other studies [18]. There were 1.73% neonates with Hemangioma in this study, Mishra PC, et al reported similar incidence [19]. 0.34% neonates presented as collodian baby, seborrheic dermatitis, and café – au-lait in this study. There was one case of Harlequin’s fetus (0.17%). Sarkar reported an incidence of 0.11% [20] 0.17% neonates in this study had Epidermolysis bullosa, Sucking Blister Scalded Skin Syndrome, and Neonatal pustular melanosis. The pattern of skin infection in neonate is also different then other studies reported in regional and international studies [21-27].
Limitation of study: Sort duration of study two year, small number of cases, relation of skin lesions to preterm, term, post term neonates, and low birth weight / normal weight neonate was not studied.
 
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