Neonates At Birth

Looks of neonates at birth often shatters the imagination of the parents. Without a realistic preparation, a new mother may well be shocked by the physical appearance of her offspring. However, parental instinct gives most parents the extraordinary capacity to accept the baby as she is, but sometimes it could be a cause of great shock.

Newborn Baby
Note The Hairy Wrinkled Skin

Just after the birth, a neonate very rarely resembles the chubby rose cheek picture that we associate with the newborns. Do not be disheartened. This is only a very short transitional phase. Your dream picture will soon emerge!

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What to expect?

Newborn babies have a big head, practically no neck, slightly protruding prominent abdomen with umbilical cord in the centre and short limbs. Their skin is wrinkled often in somewhat loose folds with slightly bluish discoloration of the extremities. They are wet, covered in streaks of blood, and coated with a white sticky cheese like substance, known as “vernix caseosa”.

Neonates Just after the Birth

Vernix caseosa

Vernix caseosa is a Latin name where vernix means varnish and caseosa means cheesy. Have a look at a neonate with vernix caseosa.

Vernix Caseosa
The White Cheesy Biofilm Covering The Skin of the Newborns

Benefits of Vernix Caseosa

Moisturizing the fetus's skin
Protects baby's skin from ill effects of the constituents in amniotic fluid.
Lubricant effect: Facilitates passage through the birth canal.
Serves to conserve heat.
Believed to possess antibacterial effect by being a physical barrier to the passage of bacteria.

How can vernix caseosa be removed?

Most of the vernix caseosa gets wiped on to the baby’s linen.
Some of it melts away and some is believed to be absorbed by the skin within 8 hours of birth.
For aesthetic reasons it is often wiped or washed off.
It is most easily wiped off by cotton soaked in oil.

1.) Cleans the baby

2.) Protects the skin from atmospheric effects of drying

3.) Prevents newborn's body heat loss and gives time for the body temperature to get stabilized.

Gestational Age Related Differences in Skin of Newborn Babies

Post-term newborn infants characteristically have little or no vernix caseosa. Consequently, the skin of postmature neonates gets dry, cracked and wrinkled. It may also show areas of peeling. Severe degree of peeling suggests an inherited disorder: "Ichthyosis Congenita", which demands medical management.

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Lanugo hair

Lanugo Hair

Some babies have hairy body at birth. These fine textured hair are called “Lanugo Hair”. They are particularly noticeable over the shoulders, back of thighs, forehead, ears and sometimes even on the face. It could be a very disturbing site for the mother, but it is only a very normal transitional phase of development.

The fine fur on the body of the fetus is normal. It thins out as the baby approaches term. Therefore most premature babies have plentiful lanugo hair, while those born after 42 weeks of gestation (post-mature) notably have none.

Vellus hair

The vellus hair are short, fine, light-coloured, and barely noticeable. They replace the lanugo hair as the baby grows. Even infants and toddlers have vellus hair on the body.

Though the density of growth and thickness of hair varies from child to child, tufts of hair over the lower (lumbosacral) spine calls for medical attention. This could be a sign of an underlying abnormality such as occult spina bifida, a sinus tract, or a tumour.

Mongolian spots

Another cause for parents to get startled at the site of their neonate is the presence of large bluish grey or pinkish purple blotches on the skin. They are most commonly located on the lower back and the buttocks, but can occur anywhere on neonate’s body. They may be single or many. They vary in shape and size - from few millimetres to several centimeters.

Mongolian Spots
Large Bluish Grey Blotches, That Resemble Bruises, Seen on Infants’ Skin in Various Shapes, Sizes, and Numbers.

Prevalence

More than 90 percent of black, 81 percent of Asians, and 10 percent of white babies are born with Mongolian spots, boys and girls being equally predisposed to the condition.

Why do babies develop Mongolian spots

The Mongolian spots are the result of abnormal collection of pigment cells in the deeper layer of the skin, the dermis. They can be mistaken for bruises. They are the result of innocent development disorder at embryonic stage of cells migration.

What is the impact of Mongolian spots on child health?

The spots are harmless. Despite the name Mongolian spots, they have no known effect on childhood development, cognitive capabilities or psychosocial development.

What is the treatment for Mongolian spots?

No treatment of any kind is indicated.
They disappear on their own as the child grows.
Most disappear by 12-16 months of age, but some may take 3-4 years.

If Mongolian spots do not disappear till after the fifth birthday, a dermatologist’s consultation should be sought.

Milia (Milk Spots)

Milia are 1-2millimeter whitish pearls seen on the skin of the face of 40 percent of full term newborns.

Milia, In Newborns, Are Harmless, Small White Bumps Under The Surface Of Skin.
Those >2 millimeter Need Medical Evaluation To Rule Out Any Underlying Disorder.

Pearly White, Harmless Bumps
Commonly Seen On The Skin Of The Face

Why do Milia occur?

They occur when superficial dead skin becomes trapped in small pockets of sebaceous apparatus of vellus hair at the surface of the skin.

Distribution

They are sparsely scattered on nose, cheeks, forehead and chin. Rarely Milia may occur in unusual sites, such as on arms, legs or the foreskin.

What is the treatment for Milia?

Milia do not need any treatment.
They disappear on their own.
The time they take to disappear is variable; usually it is few weeks.
They do not leave any lasting effects.
Milia larger than 2 millimeter should be medically evaluated to rule out any underlying disorder.