Skin diseases of newborns. Skin diseases in newborns

For citation: Suvorova K.N. SKIN DISEASES IN CHILDREN OF THE FIRST YEAR OF LIFE: DIAGNOSIS QUESTIONS // BC. 1996. No. 10. S. 1

The management of newborns and infants suffering from skin diseases requires precise decisions and prompt actions from a dermatologist, the effectiveness of which largely depends on correct and timely diagnosis. Pediatric dermatovenereology has now turned out to be not only extremely responsible, but also the most difficult area for dermatovenereologists. Despite the fact that doctors of various specialties are involved in the treatment of children with skin pathology, it is not possible to achieve satisfactory results in terms of reducing the level of the disease and increasing the effectiveness of preventive care. The number of diagnostic errors is especially high. Pediatric dermatology is closely related to the prevention of hereditary pathology, since the birth of a sick child encourages relatives to consult a doctor to determine the genetic prognosis. Raising the level of professional nosological diagnostics is the initial and necessary condition for the development of therapeutic, preventive and medical genetic assistance. Offered short reviews on diagnostics, treatment, prevention and rehabilitation of children suffering from skin and venereal diseases.

The management of newborns and infants suffering from skin diseases requires precise decisions and prompt actions from a dermatologist, the effectiveness of which largely depends on correct and timely diagnosis. Pediatric dermatovenereology has now turned out to be not only extremely responsible, but also the most difficult area for dermatovenereologists. Despite the fact that doctors of various specialties are involved in the treatment of children with skin pathology, it is not possible to achieve satisfactory results in terms of reducing the level of the disease and increasing the effectiveness of preventive care. The number of diagnostic errors is especially high. Pediatric dermatology is closely related to the prevention of hereditary pathology, since the birth of a sick child encourages relatives to consult a doctor to determine the genetic prognosis. Raising the level of professional nosological diagnostics is the initial and necessary condition for the development of therapeutic, preventive and medical genetic assistance. Brief reviews are offered on the issues of diagnosis, treatment, prevention and rehabilitation of children suffering from skin and venereal diseases.

To cure neonates and babies who suffer from skin diseases requires that a dermatovenerologist should take accurate decisions and make prompt actions whose efficiency largely depends on correct and timely diagnosis. Pediatric dermatovenereology has proven to be not only a highly crucial but the most chalenging area for dermatovenereologysts. Despite the fact that physicians of various disciplines participate in the treatment of infants with skin abnormalities, there are no saticfactory results in reducing incidence rates and enhancing therapeutical and preventive care.
There are a great deal of diagnostic errors. Pediatric dermatovenereology is closely associated with the prevention of hereditary pathology as the birth of an ill baby makes his relatives to visit a doctor to determine a genetic prognosis. To enhance the level of professional nosological diagnosis is a primary and essential condition for the development of therapeutical, prophylactic, and medical and genetic care.
Brief reviews on 1) diagnosis, 2) treatment, prevention, rehabilitation of infants, with skin and venereal diseases are proposed.

Department of Dermatovenereology (Head - Doctor of Medical Sciences Prof. K. N. Suvorova) of the Russian Medical Academy of Postgraduate Education.
Prof. K.N. Suvorova, MD, Head of the Department of Dermatovenerology, Russian Medical Academy of Postgraduate Training

Introduction

In children of the first year of life, various skin lesions are found more often than in other age groups. The pathology of the skin during this period is distinguished by a pronounced specificity of the nosological profile and the unusual clinical manifestations of dermatosis, which are also known in adults, but manifest differently. A dermatovenereologist should be aware of the special skin conditions in newborns, specific approaches to the treatment of dermatosis, and the characteristics of the child's body. infancy that determine his reactions to medications or contribute to the aggravation and chronicity of dermatoses and the development of complications typical of this age. In the first months of life, suddenly severe and acute dermatoses can occur, when an accurate diagnosis and urgent care are urgently needed, which can only be provided by the joint efforts of pediatricians and dermatologists. Secondary skin lesions may occur in congenital metabolic defects and other multiple organ syndromes with onset in infancy; a dermatologist, having an adequate understanding of such diseases, should refer the child to a pediatrician and other specialist in a timely manner in accordance with their diagnostic assumptions. On the other hand, often the most common skin lesions are first discovered by a pediatrician who constantly monitors the child. In such cases, he should be able to suspect a skin disease and refer the child to a dermatologist.
The task of the pediatrician is to identify and treat internal diseases that contribute to the exacerbation or torpid course of dermatosis, and the dermatovenereologist is obliged to correctly diagnose skin and venereal diseases, at whatever age they occur, based on professional knowledge of the semiotics of dermatosis and sexually transmitted diseases, and the ability to use special methods of nosological recognition. Knowing the main etiological and pathogenetic methods of treating dermatoses, a dermatovenereologist must determine the stages of therapy, use various options for special treatment with various topical agents, and carry out rehabilitation. According to the professional and job requirements for a specialist, every dermatovenereologist should know pediatric dermatovenereology, since there is no separate specialty in this discipline. In practice, this section, especially skin pathology in children of the first year of life, is the most difficult for a dermatovenereologist. Based on the experience of the Department of Dermatovenereology of the Russian Medical Academy of Postgraduate Education and the Children's Department of the Moscow Clinical Dermatovenerological Hospital No. 14, we propose to discuss some issues related to this area.

Conclusion

Reliable nosological recognition of skin diseases in newborns and infants must be carried out as soon as possible. This possibility is provided by the visual accessibility of the organ, provided that the clinical and morphological analysis of eruptive elements is professionally performed, the correct assessment of age-dependent symptoms, specific differential diagnosis within the nosological profile of each age interval, knowledge of the age-related evolutionary dynamics of skin pathology.

Literature:

1 . F. Zverkova. Skin diseases in young children. Saint Petersburg. - Sothis. -1994 - 235 p.
2. K.N. Suvorov, A.A. Antoniev, N.P. Kuznetsova, I.O. Malova. Skin and venereal diseases in children. .Irkutsk, - Irkutsk University Publishing House. -1995.
3. Yu.K. Skripkin, G.Ya. Sharapova. Skin and venereal diseases. - M.: - Medicine. -1972.
4. Yu.K. Skripkin, F.A. Zverkova, G.Ya. Sharapova, A.A. Studnitsin. Guide to pediatric dermatovenereology. - A.; Medicine. - 1983.

Quite often, after birth, a child develops skin diseases, and such diseases can be very dangerous. A newborn baby has very delicate skin. Its cover consists of keratinized cells. For this reason, it is very vulnerable and serves as "excellent soil" for all kinds of infections.

Skin diseases of newborns can be dangerous for the baby, so they need to be treated under the supervision of a specialist, identifying the cause of these diseases. Self-medicate in this case is prohibited because we are talking about a baby who is just beginning to adapt to this world.

Skin diseases of the breast

In newborns sweat glands still underdeveloped and with frequent overheating, sweating may appear. It is expressed as small pimples that are located throughout the body. Prickly heat usually goes away on its own, but its frequent appearance suggests that the baby often overheats, so do not wrap the baby too much, because a strong overheating of the child can cause the worst outcome.

A few days after the baby is born, a patchy, swollen rash may appear - hives or urticaria. Urticaria mainly affects the body of the baby, it does not require special treatment, after a while it goes away on its own.

Such skin disease how scabies affects the feet and hands of a child and is accompanied by a rash and severe itching. Infection occurs through contact with a sick person, the whole family can become infected with the disease. This disease should be treated according to the recommendations of a specialist.

Vesiculosis or small pemphigus occurs in newborns and infants. With this skin disease, the baby has small blisters filled with a clear, sometimes yellowish liquid. They mainly affect the neck, groin, and scalp. Such bubbles burst in a few days, becoming covered with a crust. Without timely treatment this disease can affect the entire body of the child. With this rash, the baby should be shown to the doctor. He will appoint the right treatment. This disease can be confused with the most dangerous disease- pemphigus of newborns or pemphigus, which occurs due to pathogenic microbes.

Other skin diseases in newborns

After the birth of the baby, such a skin disease as "strawberry nevi" may appear. It is expressed by red spots that rise above the skin. Such spots grow during the first year of a baby's life. They affect the face, neck and body. With age, such a disease disappears, but nevertheless, such a disease needs appropriate treatment, especially if the spots are located near the eyes. Also, immediately after birth, the baby may develop such a disease as simple nevi, also called the “stork bite”. It is expressed on the back of the head and neck, in the form of reddened spots. Over time, such spots in the child disappear.

Some infants have skin conditions such as infantile. The child's skin is exposed small spots that cause itching. Such a disease should be treated with the help of the recommendations of a dermatologist.

Seborrheic dermatitis in infants affects the face, chest, knees and elbows, but mostly this dermatitis affects the scalp. The peak of the manifestation of such a disease by the age of three months in a child. Dry and yellow scales appear on the head, a red rash affects the body. This disease should be treated under the supervision of a specialist.

Tight swaddling of newborns, increasing friction between the skin and clothes, can lead to a disease - diaper dermatitis. From constant friction and urine on areas of the body, the skin becomes red (especially in groin areas), resulting in pain and skin irritation. Should apply disposable diapers, use hygiene products when changing diapers ( special oils, powders), do baths more often, undress the baby more often so that the body dries up (the temperature of the room must be appropriate).

In newborns, treatment of skin diseases should only take place under the supervision of a doctor, as some skin rashes can be a symptom of various life-threatening diseases. Therefore, it is necessary to eliminate first of all the cause of the formation of skin diseases in infants.

Nursing process for non-infectious and infectious diseases of the skin and umbilical wound of the newborn, sepsis of the newborn

Lecture #4

Lecture plan:

1. Classification of diseases of the skin and umbilical wound in newborns.

2. Non-infectious diseases of the skin and umbilical wound. Definition. The incidence rate. The main causes and risk factors for development. Clinical manifestations and complications. Principles of treatment and planning of nursing care for patients. Prevention.

3. Pyoderma. Definition. The incidence rate. The main causes and risk factors for development. Clinical manifestations and complications of diseases. Principles of treatment and planning of nursing care for patients. Prevention.

4. Sepsis of newborns. Definition. The incidence rate. The main causes and risk factors for development. Clinical manifestations and complications. Principles of treatment and planning of nursing care for patients. Prevention.

5. Nursing process in purulent-septic diseases of newborns.

All diseases of the skin and umbilical wound can be divided into two large groups:

Noncommunicable diseases:

diaper rash

· Prickly heat

Scleredema, sclerema.

· Umbilical hernia

Fistulas of the navel

fungus navel

Infectious diseases (bacterial, localized purulent-septic)

Vesiculopustulosis

Pemphigus of newborns

exfoliative dermatitis

Pseudofurunculosis

Omphalitis

Generalized purulent-septic diseases include neonatal sepsis.

Non-infectious diseases of the skin of a newborn child:

Prickly heat. It is a red punctate rash on the trunk, neck, inner surfaces of the limbs. Appears due to sweat retention in the excretory ducts of the sweat glands when the child overheats or lacks hygienic skin care. General state the child is not disturbed, T about the body is normal. Elements of the rash can become infected with the development of pyoderma.

Treatment consists in eliminating the cause of increased sweating, conducting hygienic baths with potassium permanganate, decoctions of chamomile, calendula, string daily.

Diaper rash. The occurrence of diaper rash is associated with defects in care - a rare change of diapers and diapers, irregular hygienic baths and washing, reuse of dried diapers. In children with diathesis, there is a tendency to rapidly emerging and persistent diaper rash. Diaper rash is more often located in the buttocks, genitals, and also in skin folds. There are three degrees of rash:

I. Moderate redness of the skin

II. Brilliant red with large erosions.

III. Brilliant redness and weeping from coalescing erosions.

Diaper rash with a violation of the integrity of the skin can become infected.

Treatment involves changing diapers and swaddling or changing the baby before each feeding, air baths, UFO. With hyperemia of the skin, it is lubricated with boiled vegetable oil, fatty solution of vitamin A, baby cream, disinfectant and skin-protecting powders are used. Simultaneous use of powders and oils on the same skin areas is not allowed. In case of erosion, the skin is treated with a 0.5% solution of resorcinol, a 1.25% solution of silver nitrate, and talcum powder. It is recommended to add a decoction of oak bark, chamomile to the water during hygienic baths.

Scleredema and sclerema . This is a woody density swelling of the skin and subcutaneous tissue. More often observed in premature babies with hypothermia. With scleredema, foci of compaction appear on the lower leg, feet, above the pubis, on the genitals, and can capture other parts of the body. Unlike sclerema, they do not tend to generalize. The skin over the lesion is tense, cold to the touch, has a cyanotic hue, does not form a fold. When pressed with a finger, a depression remains, which disappears very slowly. Good care and warming of the child lead after a few weeks to the disappearance of seals.

Sclerema is characterized by the appearance of diffuse compaction, more often in the region of the muscles of the lower leg and on the face, then spreads to the trunk, buttocks and limbs. No indentations are formed when pressing on the skin. The affected areas appear atrophied, the face is mask-like, the movements in the limbs are limited. T about the body is reduced. Children are lethargic, drowsy, do not take the breast well. The general condition is severe.

For treatment, the child is placed in an incubator or covered with heating pads, warm baths are used. Cardiac agents, corticosteroid hormones, oxygen therapy are shown. The prognosis is unfavorable.

Non-communicable diseases of the navel of a newborn child:

Umbilical hernia – this is a protrusion in the region of the umbilical ring, which increases with the cry or anxiety of the child. On palpation, a wide umbilical ring is determined. The child's condition is not disturbed, but in case of infringement with small sizes and dense edges of the umbilical ring, pain reactions are possible.

Treatment, as a rule, conservative: Massaging the anterior abdominal wall, laying the baby out before each feeding on the stomach for 10-15 minutes. With the appearance of a sharp anxiety, under the supervision of a doctor, an umbilical hernia is reduced in a bath with a T about water of 36-37 ° C. The need for surgical treatment rarely occurs.

Fistulas of the navel are complete and incomplete. Complete fistulas are associated with the cleft of the vitelline duct, located between the umbilicus and the loop of the intestine, or the preservation of the urinary duct, connecting bladder with allantois. Incomplete fistulas occur due to non-closure of the distal urinary or vitelline ducts.

Fistulas are manifested by persistent weeping of the umbilical wound. It is possible to excrete intestinal contents through the yolk duct or urine through the urinary duct with complete fistulas. Around the navel, irritation and maceration of the skin are noted. In case of layering of the infection, the discharge from the umbilical wound becomes purulent.

To confirm the diagnosis, an x-ray examination and probing of the fistulous canal are performed.

Treatment operational.

fungus navel – mushroom-shaped growth of granulation tissue at the bottom of the umbilical wound, 1-3 cm in diameter.

Treatment. After treatment of the umbilical wound, the granulations are cauterized with a 5% solution of silver nitrate or with a lapis pencil. In rare cases, there is a need for surgical treatment.

Pyoderma.

In the structure of morbidity and mortality in newborns and young children, the leading place is occupied by purulent-septic diseases.

Most often pathogens are:

Staphylococci

group B streptococci

・Escherichia coli

Pseudomonas aeruginosa

Klebsiella

microbial associations

Vesiculopustulosis – This is a pustular skin disease in newborns or children in the first months of life. It is the most common form of local infection.

Clinical manifestations:

In the natural folds of the skin, on the trunk, scalp, limbs, small superficially located vesicles appear, filled at the beginning with a transparent exudate (vesicles), and then with cloudy purulent contents (pustules).

Bubbles open in 2-3 days from the moment they appear, forming small erosions, and gradually covered with dry crusts (they do not leave scars after healing).

The general condition of the child, as a rule, does not suffer.

The course of vesiculopustulosis can be complicated by the development of infiltrates and multiple abscesses.

Pemphigus of newborns is a type of pyoderma that develops in a newborn child more often on days 3-5, less often in the second week of life.

Clinical manifestations:

· Suddenly, on the unchanged skin, multiple blisters of round and oval shape (up to several centimeters in diameter), single-chamber, filled with a transparent yellowish liquid, which later becomes cloudy, appear. The blisters are sluggish in consistency, their walls are thin, they are easily opened, forming a bright red erosion.

Localization of blisters more often on the back, abdomen, in the axillary and inguinal skin folds.

Rashes occur in shocks, so the rash is polymorphic.

The child's condition is severe, intoxication is pronounced, T about the body rises to 38-39 o C, the child becomes lethargic, refuses to breastfeed, gains weight poorly.

With timely treatment, recovery occurs in 2-3 weeks, however, with an unfavorable course, the disease may end in sepsis.

Exfoliative dermatitis – the most severe form of staphylococcal skin lesions in a newborn baby.

Clinical manifestations:

A diffuse hyperemia appears around the navel or mouth, after a while the epidermis detaches, and large eroded areas are exposed. The affected area gradually increases, and after 8-12 days the skin of the newborn becomes burnt (large areas of hyperemia and erosion).

The condition is serious, symptoms of intoxication are expressed, high fever is noted, the child is lethargic, refuses to breastfeed, and gains weight poorly.

Often join abscesses, phlegmon.

Pseudofurunculosis – inflammation of the sweat glands. The disease can begin with prickly heat, vesiculopustulosis. The skin of the scalp, back of the neck, back, buttocks, limbs (in places of greatest friction and pollution) is most often affected.

Clinical manifestations:

In place of the excretory ducts of the sweat glands, purple-red subcutaneous seals appear up to 1.5 cm in diameter. Later, fluctuating purulent contents appear in the center of the inflammatory focus, and after healing, a scar remains.

The child's condition is disturbed, symptoms of intoxication are noted, T about the body periodically rises.

In the presence of small multiple abscesses of the skin, regional lymph nodes are enlarged.

With timely treatment, recovery occurs in 2-3 weeks, however, with an unfavorable course, the disease can be complicated by sepsis.

Omphalitis – This inflammatory process in the umbilical region. The umbilical wound is a very convenient entrance gate for the penetration of pathogenic microorganisms.

There are three forms of omphalitis:

· Catarrhal omphalitis

Phlegmonous (purulent) omphalitis

Necrotizing omphalitis.

Catarrhal omphalitis (weeping navel) ) – develops with delayed epithelialization of the umbilical wound.

Clinical manifestations:

The umbilical wound becomes wet, serous discharge is secreted, the bottom of the wound is covered with granulations, bloody crusts may form, slight hyperemia of the bottom of the wound and moderate infiltration of the umbilical ring are noted.

· With a protracted process of epithelization, a fungus may appear at the bottom of the wound.

The condition of the newborn, as a rule, is not disturbed, T about the body is normal, the umbilical vessels are not palpated.

With timely diagnosis and treatment, the healing of the umbilical wound occurs within a few weeks. With an unfavorable course of the disease, it is possible to spread the process to the tissues adjacent to the navel and umbilical vessels.

Purulent (phlegmonous) omphalitis – characterized by the spread of the inflammatory process to the tissues around the umbilical ring (subcutaneous fat, umbilical vessels) and severe symptoms of intoxication. Purulent omphalitis may begin with symptoms of catarrhal omphalitis.

Clinical manifestations:

The skin around the navel is hyperemic, edematous, there is an expansion of the venous network on the anterior abdominal wall.

The umbilical wound is an ulcer covered with a fibrinous coating; when pressed, purulent contents are released from the navel.

· The umbilical region gradually begins to bulge above the surface of the abdomen, because. deep-lying tissues are gradually involved in the inflammatory process.

The umbilical vessels are inflamed (thicken and palpable in the form of tourniquets).

The child's condition is severe, symptoms of intoxication are expressed, he is lethargic, sucks badly at the breast, burps, T about the body rises to febrile numbers, there is no increase in body weight.

With this form of omphalitis, the child's condition is always regarded as serious, because. possible metastasis of purulent foci and the development of sepsis.

Necrotic omphalitis is extremely rare, is a complication of phlegmonous in children with low immunity.

Clinical manifestations:

The skin around the navel becomes purplish-cyanotic.

Tissue necrosis quickly spreads to all layers with the formation of a deep wound.

The child's condition is extremely serious, symptoms of intoxication are expressed.

This form of omphalitis in most cases ends in sepsis.

Basic principles of treatment of newborns with local forms of purulent-inflammatory diseases:

1. Children with vesiculopustulosis and catarrhal omphalitis without disturbing the general condition and with properly organized care can be treated at home. Other forms of localized purulent-septic diseases require inpatient treatment.

2. Etiotropic therapy:

Vesiculopustulosis: treat intact skin around the rash with a 70% solution ethyl alcohol, observing the rules of asepsis, open and remove vesicles and pustules with a sterile swab moistened with alcohol, suck out the contents of large blisters using a disposable syringe, cut off the walls of the bladder with sterile scissors, then treat the eroded surface daily with bactericidal preparations (30% dimexidine solution, chlorphilipt solution, 1% aqueous solutions of brilliant green or methylene blue), irrigate or apply dressings with staphylococcal bacteriophage. In complicated forms, antibiotic therapy is carried out in combination with immunocorrective agents, vitamin therapy, UVI.

Pseudofurunculosis: the elements are treated with 70% ethyl alcohol solution, dressings are applied with a 20% solution of dimexide or its ointment, according to indications, surgical treatment, antibacterial and restorative treatment, physiotherapy procedures.

Catarrhal omphalitis: remove crusts from the umbilical wound with a 3% solution of hydrogen peroxide, dry with 95 o (70% solution) of ethyl alcohol 2-3 times a day.

Purulent and necrotic omphalitis, pemphigus, exfoliative dermatitis are treated in a hospital according to all the principles of sepsis treatment.

4. Sepsis of newborns.

Sepsis of the newborn This is a generalized infectious disease caused by the spread of microorganisms from the primary focus to the blood and lymph, then to various organs and tissues, occurring against the background of reduced or perverted immunity. The incidence of sepsis is 0.1% in term newborns and about 1% in preterm infants. In the structure of infant mortality, sepsis ranks 3rd-4th.

Etiology:

Streptococci

・Escherichia coli

Klebsiella

Pseudomonas aeruginosa

Staphylococci

hemophilic bacillus

Virus-microbial associations

Predisposing factors: 1. Factors that violate (reduce) the anti-infective properties of natural barriers - catheterization of the umbilical and central veins, tracheal intubation, mechanical ventilation; severe respiratory viral diseases, birth defects, burns, trauma during childbirth or during surgical interventions; decrease in intestinal resistance in intestinal dysbacteriosis. 2. Factors that inhibit the immunological reactivity of the newborn - a complicated antenatal period, pathology in childbirth leading to asphyxia, intracranial birth trauma, viral diseases, hereditary immunodeficiency states, malnutrition of a pregnant woman. 3. Factors that increase the risk of massive bacterial contamination of the child and the risk of infection with hospital flora - an anhydrous interval of more than 12 hours, an unfavorable sanitary and epidemic situation in maternity hospital or hospital (there is a possibility of cross-infection), severe infections mother at the time of delivery or after. 4. Purulent-inflammatory diseases in the 1st week of life. A child is especially sensitive to infection at the time of birth and in the first days of life, which is associated with an excess of glucocorticoids in his blood, transient dysbiocenosis, the formation of an immunological barrier of the mucous membranes and skin, and the catabolic orientation of protein metabolism.

Pathogenesis. The entrance gates of infection are: the umbilical wound, injured skin and mucous membranes (at the site of injection, catheterization, intubation, probes, etc.), intestines, lungs, less often - the middle ear, eyes, urinary tract. In cases where the entrance gate of infection is not established, cryptogenic sepsis is diagnosed. The source of infection can be medical staff and a sick child. The ways of transmission of infection are the birth canal of the mother, the hands of the staff, tools, equipment, care items. The following main links in the pathogenesis of sepsis are distinguished: entrance gates, local inflammatory focus, bacteremia, sensitization and restructuring of the body's immunological reactivity, septicemia and septicopyemia.

clinical picture.

Signs of sepsis:

Late fall of the umbilical cord

Sluggish healing of the umbilical wound

Elements of pustules on the skin

Mucus discharge from the nose

No weight gain

Protracted jaundice

Early signs of sepsis:

General restlessness of the child, replaced by lethargy

Pallor of the skin, cyanosis of the nasolabial triangle, acrocyanosis

・Frequent vomiting

Decreased appetite, refusal to breastfeed

Increasing toxicity

Local purulent focus

Signs of sepsis in the peak period:

The skin is dry, pale with a grayish-cyanotic tint. Then dryness of the skin is replaced by swelling, pastosity with areas of sclera, tissue turgor decreases, multiple pustules or a hemorrhagic rash may appear.

· Inconstancy of T about the body (from subfebrile to hectic).

Dyspeptic disorders: persistent regurgitation, loss of appetite up to anorexia, unstable stool lead to a drop in body weight

Changes in the cardiovascular system: hypotension, arrhythmia, expansion of the boundaries of the heart, deafness of heart tones, impaired microcirculation (marbling of the skin, a symptom of a "white" spot), a collaptoid state may develop.

Changes in the respiratory system: shortness of breath, apnea.

Enlargement of the liver and spleen.

There are two clinical forms sepsis:

· Septicemia- arises in connection with the massive entry into the bloodstream of pathogenic organisms, proceeds without visible local purulent-inflammatory foci, has an acute course. Characteristic: pronounced symptoms of intoxication, high fever, pallor and cyanosis of the skin, dyspeptic disorders, changes in the cardiovascular system, rapid weight loss, septic hepatitis. The child can die from septic shock within a short time. More commonly seen in premature babies.

· Septicopyemia- characterized by an undulating course due to the constant development of new metastatic foci in the body. Characteristic: pronounced symptoms of intoxication, signs of respiratory and cardiovascular insufficiency, constantly emerging new purulent metastatic foci in various organs. It develops more often in full-term children.

Diagnostic methods:

1. Clinical blood test.

2. Bacteriological examination of blood, cerebrospinal fluid, etc.

The prognosis for sepsis depends on the virulence of the pathogen, the state of the child's immunity, the timeliness and adequacy of therapy. It remains serious in children at risk (they die in 15-30% of cases).

Basic principles of treatment of neonatal sepsis:

1. Protective mode, if possible a separate sterile box, use sterile underwear.

2. Feeding the baby with breast milk, the method of feeding according to the state.

3. Drug therapy:

· Antibacterial drugs: a combination of several antibiotics by different routes of administration (ampicillin with aminoglycosides or cephalosporins). Change of courses every 7-10 days.

Detoxification therapy, maintenance of BCC: plasma, 5% glucose solution, isotonic electrolyte solutions, albumin, reopoliglyukin.

Immunocorrective therapy: specific immunoglobulin, blood products, plasma.

· Local treatment pyemic foci (omphalitis, pyoderma, etc.).

Pathogenetic and symptomatic therapy: enzymes, vitamins, cardiac preparations, biologics, angioprotectors, antiplatelet agents, anticoagulants, etc.

4. Physiotherapy: microwave, UHF, etc.

5. Phytotherapy: therapeutic baths with infusions of string, chamomile, St. John's wort, decoctions of oak bark, birch buds.

Dermatovenereology: a textbook for higher students educational institutions/ V. V. Chebotarev, O. B. Tamrazova, N. V. Chebotareva, A. V. Odinets. -2013. - 584 p. : ill.

Chapter 3

Hemangiomas

Hemangiomas (haemangioma)- the most common skin tumors in newborns, they are detected in 5-7% of children. Hemangiomas are true vascular nevi that develop from blood vessels. They are capillary, cavernous, in the form of flaming nevi.

. Capillary hemangioma occurs for the first time a few weeks after birth and undergoes spontaneous regression within 2-4 years. Often located in the head or neck, less often - on the trunk, legs. The tumor is a flattened nodular element or plaque of a soft, bright red color, with irregular outlines, sharp borders and a slightly bumpy surface (Fig. 3-1). With vitropressure, the color of the element does not turn pale - the main difference from telangiectasias. After the regression of the hemangioma, cicatricial atrophy remains. Treatment is not required.

. Cavernous hemangioma characterized by multiple vascular hyperplasia and the formation of dilated vascular cavities located deep in the dermis or hypodermis. Node boundaries are blurred. The skin color is not changed or has a reddish-bluish tinge. Sometimes large cavernous hemangiomas grow rapidly and are complicated by thrombocytopenia. (Kazabakh-Merritt syndrome). Patients with cavernous hemangiomas are observed by a pediatrician and pediatric surgeon.

. Flaming nevus - malformation of the capillaries of the dermis in the form of their persistent, irreversible dilatation. The face is usually affected. It is clinically characterized by a spot of bright red "wine" color with irregular outlines and clear boundaries. Cosmetic correction is possible.

Rice. 3-1.Capillary hemangioma

Congenital aplasia of the skin

Congenital aplasia of the skin (aplasia cutis congenita) and subcutaneous adipose tissue in limited areas of the scalp, less often the trunk, with a diameter of 0.2 to 3-4 cm, is detected already at the time of birth (Fig. 3-2). The process ends with scarring. Perhaps a combination with other malformations. Treatment is reduced to protection from infection and damage, stimulation of the healing of the skin defect.

Rice. 3-2.Congenital aplasia of the skin

Adiponecrosis

Adiponecrosis (adiponecrosis)- focal necrosis of the subcutaneous

cellular tissue. It develops on the 1st-2nd week of life in the form of well-demarcated dense nodes with a diameter of 1-5 cm (sometimes more) on the buttocks, back, shoulders, limbs. The skin over the infiltrate is cyanotic, purple-red, later turns pale. Palpation of the infiltrate is painful. The general condition of the child is not disturbed, the body temperature is normal. Infiltrates spontaneously disappear without treatment within 2-4 months.

Sebaceous ichthyosis

Sebaceous ichthyosis (ichthyosis sebacea)- a peculiar condition of the skin, which is based on increased secretion of a drying secret sebaceous glands. After the disappearance of physiological erythema in the first days of life in some newborns, abundant physiological peeling of the skin is noted. At the same time, sometimes the child's body is covered with a dense brownish crust, consisting of scales and hairs. After several hygienic baths and subsequent treatment of the skin with emollient creams, the crusts disappear.

Toxic erythema of the newborn

Toxic erythema of the newborn (erythema neonatorum toxicum) develops on the 2-4th day of a child's life (but not from birth). Rashes are represented by erythematous spots, often merging with each other, as well as papules, pustules, surrounded by a hyperemic corolla. In the erythematous-papular form, there is a tendency for the elements to merge and form extensive lesions on the back, buttocks, and cheeks. The palms and soles are not affected. The course of the disease is benign, rashes disappear on their own in 1-2 weeks. Pustular elements are treated with a 1% solution of brilliant green.

Diseases of the umbilical wound

Catarrhal omphalitis

Catarrhal omphalitis (weeping navel) is characterized by the presence of hemorrhagic crusts, serous discharge from the umbilical wound after the umbilical cord falls off and a slowdown in the timing of its epithelization. In some cases, mild hyperemia and slight infiltration of the umbilical ring occur (Fig. 3-3). Condition but-

Rice. 3-3. Catarrhal omphalitis

congenital is not broken. Local treatment consists in treating the umbilical wound with a 3% hydrogen peroxide solution and lubricating with a 1% solution of aniline dyes, 1% potassium permanganate solution.

Omphalitis

Omphalitis is a bacterial inflammation of the bottom of the umbilical wound, umbilical ring, subcutaneous fatty tissue around the umbilical ring, umbilical vessels. Often the disease begins with manifestations of catarrhal omphalitis and is characterized by the presence of purulent discharge from the umbilical wound. There is a pronounced hyperemia and infiltration of tissues, the expansion of the vessels of the anterior abdominal wall, the attachment of lymphangitis are characteristic. The child's condition is disturbed, the body temperature rises to 37-38°C. With the spread of the infectious process, sepsis may develop. Treatment includes general antibiotic therapy, local treatment of the umbilical wound with aniline dyes, 1% potassium permanganate solution, antibacterial ointments.

Umbilical granuloma

umbilical granuloma (fungus, fungus)- proliferation of bluish-red granulation tissue after the umbilical cord falls off, filling umbilical wound and rising above the edges of the umbilical

rings. Umbilical granuloma is typical for newborns with a large body weight, having a thick umbilical cord and a wide umbilical ring. The child's condition is not disturbed, there are no inflammatory changes. Local treatment consists in cauterization of the granulation with a pencil with silver nitrate (lapis), as well as the use of cryodestruction or surgical excision.

Harlequin Syndrome

Harlequin syndrome - the periodic appearance of a bright red color of one half of the face, trunk and limbs and blanching of the other half of the body. Attacks occur in the first days or weeks of life and can be repeated many times. This syndrome indicates a violation of the central regulation of vascular tone. It can occur with intracranial hemorrhage and in premature babies.

transient edema

Transient edema develops in the 1st week of life in children. The skin (more often in the limbs and genitals) is characterized by a tendency to edema. The occurrence of edema is associated with various causes: compression of tissues at birth, cooling, infection, diseases of cardio-vascular system, kidney, etc. Edema of the rear of the foot and hands may be the first sign of Shereshevsky-Turner syndrome ( chromosomal abnormality). Given the numerous causes of edema, it is necessary to understand each specific case.

Scleroderma-like diseases

Scleroderma-like diseases are considered by many authors as reactive conditions in newborns, which are more severe than other transient phenomena (edema, erythema).

Scleredema of the newborn

Scleredema of the newborn (scleroedema neonatorum) develops on the 2-4th day of a child's life. Initially, there is a slight swelling of the skin and subcutaneous fatty tissue in the area of the calf muscles, feet, genitals, then a dense swelling of the tissues develops. Edematous skin is pale, sometimes with a cyanotic tinge, cold to the touch, in a fold

does not gather, when pressed, a hole remains. The development of scleredema is associated with hypothermia of the child, especially premature, malnutrition (hypoproteinemia), severe common diseases. The prognosis is determined by concomitant diseases, since scleredema itself with good care, warming the child and rational feeding takes place within a few weeks.

Sclerema of newborns

Sclerema of newborns (sclerema neonatorum) is a more severe condition and is considered a connective tissue disease (collagenosis). Healthy children do not suffer from this disease, it is always the result of background or previous severe disorders. The condition is characterized by diffuse thickening of the skin, dense swelling of the subcutaneous adipose tissue of the extremities, and in severe cases, it spreads to the trunk and other parts of the body. When pressing on the skin, the fossa does not appear. The general condition of the child is severe, the prognosis is serious, the disease often ends in death. Treatment is carried out with glucocorticoids and symptomatic agents, transfusion of blood components, vitamins are prescribed.

Dermatitis of the anogenital area

Anogenital dermatitis is a group of diseases that develop in infants due to various reasons and includes: simple contact dermatitis, ammonia dermatitis, perianal dermatitis, anogenital candidiasis, streptoderma (papuloerosive form).

Simple contact dermatitis

Simple contact dermatitis of the anogenital area can develop in children younger age when using disposable synthetic diapers (pampers), as well as diapers washed using aggressive detergents. Clinically given state characterized by diffuse erythema of the skin in contact with the diaper or tissue, with clear boundaries and not extending beyond the diapers. At contact dermatitis it is necessary to replace ordinary diapers with hypoallergenic types or completely abandon them, and when washing diapers, use non-detergents,

A baby soap. Externally on irritated skin prescribe powders with talc, agitated suspensions, as well as external glucocorticoids (hydrocortisone ointment, creams with methylprednisolone aceponate, alklomethasone, etc.).

Ammonia dermatitis

Ammonia dermatitis (diaper dermatitis) is diaper rash in the anogenital region caused by maceration and irritation of the skin by urine and feces. The development of dermatitis is facilitated by a rare change of diapers and diapers, the use of waterproof shorts, frequent liquid stool with an alkaline or sharply acidic reaction. In mild cases, the lesion is limited to areas of the skin that are directly irritated by urine and feces: buttocks, back and inner surface thighs, genitals, perineum. The skin in these areas is hyperemic, bright red, shiny, "lacquered", erosion occurs in the folds, peeling occurs along the periphery of the foci. After removing the irritation, the rashes gradually regress.

Limited variant of ammonia dermatitis - perianal dermatitis, which develops in the intergluteal fold. This lesion is observed in children with dyspeptic symptoms, dysbacteriosis. Clinically, manifestations are characterized by erythema and slight swelling of the skin around the anus.

External treatment includes the use of indifferent pastes ( special creams under diapers, with zinc oxide, drapolene *, etc.), as well as powders with talc and zinc oxide. For the prevention of ammonia dermatitis in young children, it is recommended that at each change of diapers and diapers, after cleansing the skin, apply barrier products to the anogenital area. protective cream or a paste that prevents skin contact with liquids (special creams for diapers, soft zinc pastes, Vaseline oil etc.).

Anogenital candidiasis

Anogenital candidiasis develops in young children against the background of already existing ammonia dermatitis, diaper rash, and also as a complication of antibiotic therapy (with comorbidities). Rashes are represented by bright red erythematous spots with clear boundaries, erosions with the edge of exfoliated epidermis, single vesicular elements on healthy skin(Fig. 3-4).

Rice. 3-4.Anogenital candidiasis

The rash is localized around the genitals, in inguinal folds and folds of the anus. External treatment consists in the use of antimycotic external agents: 1% clotrimazole cream 2-3 times a day for 5-7 days, powders with clotrimazole at each diaper change, as well as barrier protective creams and pastes on the anogenital area.

Streptoderma of the anogenital region

Streptoderma of the anogenital region (papulo-erosive streptoderma, syphiloid papular impetigo) is a disease

developing in young children when joining streptococcal infection against the background of diaper rash and ammonia dermatitis. Rashes are represented by lenticular papules, single erosions located on an erythematous background. With a widespread infection, antibiotics are prescribed a wide range actions. The external anogenital area is treated with antiseptic solutions (0.05% solutions of chlorhexidine, nitrofural, miramistin *, 0.5% potassium permanganate solution, etc.) 1-2 times a day, apply antibacterial ointments (2% lincomycin ointment, 1% erythromycin ointment, mupirocin, bacitracin + neomycin, etc.).

Diseases associated with sebaceous gland hyperplasia in infants

Most newborns and infants experience a hormonal crisis caused by exposure to circulating sex hormones transmitted transplacentally. In some cases, skin lesions develop associated with inflammation of hyperplastic sebaceous glands: inflammation of sebaceous cysts, neonatal acne, gneiss, seborrheic dermatitis, generalized Leiner-Moussou dermatitis.

Inflammation of sebaceous (miliary) cysts

Inflammation of the sebaceous (miliary) cysts is characterized by the appearance of a corolla of inflammation around the milia. Outwardly elements process aqueous solutions aniline dyes (1% brilliant green solution, 1% methylene blue solution).

neonatal acne

Neonatal acne (acne of babies) is observed in children up to 1-2 years of age. They are characterized by grouped papules and inflammatory acne localized on the face (forehead, cheeks, chin), often ending in the formation of punctate scars (Fig. 3-5). With age, acne disappears on its own. Appointed for rashes antiseptic solutions, aniline dyes, and with a common process - 1% erythromycin or chloramphenicol alcohol, zinc acetate + erythromycin (lotion), adapalene cream, etc.

Rice. 3-5. neonatal acne

Gneiss

Gneiss occurs in more than 1/2 of newborns and infants (up to 1-1.5 years old) and is characterized by the appearance of multi-layer fatty scales or scales on the scalp (especially the parietal region) (Fig. 3-6). In some cases, when bad care scales are located on hyperemic edematous skin, which is associated with the addition of conditionally pathogenic flora. Moderate gneiss does not require treatment. With massive layers, it is possible to soften the scales with 1% salicylic ointment or vegetable oil, followed by soft combing out with a children's bristle comb. In the presence of inflammation, antimycotic agents (clotrimazole cream), combined glucocorticoid preparations (hydrocortisone cream + natamycin + neomycin), naftalan oil ointment, 10% ichthyol ointment, etc. are externally prescribed.

Rice. 3-6. Gneiss

Seborrheic dermatitis

Seborrheic dermatitis is typical for children under the age of 1 year, most pronounced in the first months of a child's life. The main elements are localized on the scalp, eyebrows, in the area of nasolabial folds and intertriginous areas - axillary, femoral folds (Fig. 3-7). The rashes are represented by erythematous-squamous foci covered with yellowish greasy scales, easily rubbed in the hands (Fig. 3-8). In the folds, they exfoliate and maceration and erosion may occur.

Desquamative erythroderma Leiner-Moussou

Leiner-Moussou desquamative erythroderma is a common seborrheic dermatitis that occurs exclusively in children of the first 3 months of life and is associated with congenital immunological disorders (decreased phagocytic activity, defects in the complement system) and immunodeficiency.

The disease develops in most children immediately after birth from erythematous infiltrated foci of bright red color with abundant peeling, located mainly in the folds (groin