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Newborn Appearance: Skin/Physical

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Newborn skin condition varies among each baby. Here are some common newborn skin characteristics:

  • Some babies, especially preemies, have an abundance of thin, fine hair (called lanugo) covering their body and face. Lanugo disappears over time. 
  • Your baby’s skin will most likely be covered with a white cheesy substance known as vernix which protects the skin from the amniotic fluid. Vernix absorbs into the skin and the remainder will wash off after a couple of baths. If your baby is born prematurely, your baby will have more vernix than if born at term.
  • “Stork bites” (nevus simplex) are small pink or red patches caused by dilated capillaries which fade usually by the child’s second birthday. These are often seen on a newborn’s eyelids, between the eyes, upper lip, and back of the neck.
  • Nevus flammeus (port wine stain or capillary malformation) is a flat reddish-purplish colored birthmark caused by dilated blood vessels. Unlike stork bites, port wine stains are present at birth and do not fade over time. The face is the most common location. Port wine stains do not require treatment; however, pulsed dye laser therapy may be an option to lighten the birthmark.
  • Hemangiomas, benign (noncancerous) tumor consisting of a collection of blood vessels in the skin, are common, especially in premature babies and female babies. Some babies are born with them while others arise within the baby’s first month life. They can grow anywhere on the body but tend to grow mostly on the face. Hemangiomas tend to grow most during the first six months of life, and growth slows between 12 and 18 months of age. After that period, they naturally start shrinking. About 90% disappear by the age of 9. Hemangiomas may disappear completely or may leave some floppy skin, a slightly veiny appearance or scarring. Depending on the location of the hemangioma, it may or may not need medical treatment.
  • Some babies, especially African-American babies, have Mongolian spots, which are bluish discolorations normally found above the buttocks. These will fade over time. 
  • Dry, peeling and flaking skin is common especially after the first couple of weeks after birth. Remember, your newborn has been floating in amniotic fluid for the past 9 1/2 months.
  • Bluish discoloration of the hands and feet (acrocyanosis) is normal after birth and is a result of your baby’s body adjusting to life outside of the womb.
  • According to the CDC, 60% of all term newborns and 80% of preterm newborns become jaundice. Jaundice is the yellow discoloration of the skin which starts in the face and moves down the body. The whites of the eyes may also become yellow. Jaundice occurs due to the build up of bilirubin in the blood and the inability of the baby’s immature liver to breakdown the bilirubin effectively and quickly. Bilirubin is the by-product of red blood cell breakdown. Bilirubin levels peak by the third to fifth day of life and then begin to drop rapidly. High levels of jaundice is very concerning since brain damage can occur if not treated. Bilirubin is excreted through urine and stool. Therefore, encouraging adequate breastmilk and/or formula intake will help to decrease bilirubin levels. If the bilirubin climbs to a concerning level, your peditrician may recommend treatment with phototherapy.  
    • Phototherapy uses blue lights to help eliminate excess bilirubin from your baby’s bloodstream. During phototherapy, your baby will remain in an isolette (to prevent heat loss) or a crib, will be dressed only in his diaper (to maximize exposure to the bililights), and will have his eyes covered to protect his eyes from the light until feeding time. The goal is to maximize exposure time to the bililights to assist in the excretion of bilirubin from the bloodstream
  • Normally, the umbilical ring closes to make a belly button after the umbilical cord has fallen off. Some newborns are born with an umbilical hernia. An umbilical hernia occurs when intestines, abdominal lining and/or other abdominal organs protrude through an open umbilical ring causing a bulging around the belly button. Most hernias close spontaneously by 3-4 years of age. If a hernia is still present after 4-6 years of age, surgery is generally recommended. Surgery is also necessary if the hernia becomes incarcerated. An incarceration occurs when the protruding abdominal contents get stuck and cannot be pushed back into the abdominal cavity. A hernia may or may not become strangulated. A strangulated hernia means that the blood supply is cut off from the hernia contents. This is a rare event, but is very dangerous because the bowel will lose blood supply and begin to die.
 
 
Sources:
Centers for Disease Control and Prevention. Facts about Jaundice and Kernicterus. http://www.cdc.gov/ncbddd/jaundice/facts.html
Davidson, D., London, M., Ladewig, P. (2012). Olds' Maternal-Newborn Nursing & Women's Health Across the Lifespan (9th Edition). Boston: Pearson.
Gleason, C. & Devaskar, S. (2012). Avery's Diseases of the Newborn (9th Edition). Philadelphia: Elsevier Saunders.
McLaughlin, M., O'Connor, N. & Ham, P. (2008). Newborn Skin: Part II Birthmarks. American Family Physician. Jan 1;77(1):56-60. Accessed December 31, 2012 http://www.aafp.org/afp/2008/0101/p56.html
 

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