CLINICAL PROFILE, ETIOLOGICAL SPECTRUM AND RISK FACTORS OF NEONATAL PUSTULAR DERMATOSES IN A TERTIARY CARE HOSPITAL.

The skin experiences major structural and functional changes throughout the newborn period, which is a special time of fast physiological adaptation. Neonates often have a range of dermatological symptoms due to the immaturity of the epidermal barrier, changed immunological responses, and changing microbial colonisation. Pustular dermatoses are an important subclass of these since they can be either benign physiological states or potentially serious infection illnesses. A wide range of illnesses, such as erythema toxicum neonatorum (ETN), transient neonatal pustular melanosis (TNPM), miliaria pustulosa, neonatal candidiasis, impetigo, and staphylococcal skin infections, can cause newborn pustular eruptions. While infectious lesions may need close observation and antimicrobial treatments, benign diseases like ETN and TNPM usually go away on their own.

Because many illnesses have similar physical characteristics, clinical diagnosis can be difficult. Neonatal skin diseases are largely influenced by maternal and perinatal factors. Neonatal microbial colonisation may be impacted by maternal illnesses, protracted rupture of membranes, gestational diabetes, prenatal antibiotic exposure, and vaginal candidiasis. Neonates are also at risk for infectious dermatoses due to changes in skin integrity and immunological defence systems caused by prematurity, low birth weight, NICU admission, invasive procedures, and exposure to neonatal antibiotics. The development and course of neonatal skin lesions may also be influenced by environmental factors such oil application, conventional skin treatments, hygienic standards, and rooming-in habits. Traditional methods of caring for newborns' skin are still prevalent in many underdeveloped nations, which may have an impact on microbial colonisation and the function of the skin barrier.

Despite the fact that neonatal pustular dermatoses are common in paediatric practice, only a small number of Indian research have thoroughly examined their etiological spectrum and risk factors. Comprehending these variables is crucial for enhancing the precision of diagnosis, reducing pointless research, and guaranteeing suitable therapeutic measures. In a tertiary care teaching hospital, the current study was conducted to assess the clinical profile, etiological spectrum, and related maternal-neonatal risk factors of neonates presenting with pustular dermatoses.

OBJECTIVES

Primary Objective

To determine the risk variables for neonatal pustular dermatoses in mothers and newborns.

Secondary Objective

·         To outline the clinical characteristics of pustular dermatoses in newborns.

·         To identify the range of aetiologies in newborns with pustular lesions.

·         To evaluate results and determine whether antibiotic therapy is necessary.

Study Design

Observational study with a prospective focus.

Study Setting

Sree Mookambika Institute of Medical Sciences, Kulasekaram, Tamil Nadu, India; Department of Paediatrics and Neonatal Care Unit.

Study Duration

1 year.

Study Population

During the study period, newborns with pustular skin lesions were seen.

Sample Size

59 newborns.

Inclusion Criteria

·         Infants 0–28 days of age.

·         Skin lesions that are vesiculopustular or pustular.

·         A parent or legal guardian who is prepared to give informed permission.

Exclusion Criteria

·         Serious congenital skin conditions.

·         Genodermatoses.

·         Inadequate clinical information.

Data Collection

Information about maternal, neonatal, and environmental risk variables was gathered using a structured proforma.

Maternal Aspects

·         The age of the mother

·         Gravidity

·         Fever in mothers

·         An infection of the urinary tract

·         Candida vaginalis

·         Diabetes mellitus during pregnancy

·         Hypertension brought on by pregnancy

·         Chorioamnionitis

·         Extended membrane rupture (>18 hours)

·         Antibiotic exposure during pregnancy

·         Delivery method

Newborn Aspects

·         Sex

·         Age at gestation

·         Weight at birth

·         Status of low birth weight

·         Small in relation to gestational age

·         Admission to the NICU

·         Exposure to antibiotics

·         Phototherapy

·         Invasive techniques

Environmental Aspects

·         The use of oil

·         Conventional skin care

·         Practices of hygiene

·         Rooming-in procedures

·         Variation by season

Clinical information was recorded, including the location of involvement, the start of lesions, related symptoms, and the final diagnosis. Results and methods of treatment were also documented.

Statistical Analysis

SPSS version 26 was used for data entry and analysis. Categorical variables were shown as frequencies and percentages, whilst continuous variables were given as mean ± standard deviation. For a few risk factors, odds ratios with 95% confidence intervals were computed. At p<0.05, statistical significance was taken into consideration.

Table 1. Baseline Characteristics of the Study Population (n = 59)

Table 2. Maternal Risk Factors (n = 59)

Table 3. Onset of Pustular Lesions (n = 59)

Table 4. Etiological Spectrum of Neonatal Pustular Dermatoses (n = 59)

Table 5. Risk Factors Associated with Infective Pustular Dermatoses

Table 6. Treatment Profile (n = 59)

Table 7. Outcomes (n = 59)

The clinical profile, etiological range, and related maternal-neonatal risk factors of newborns with pustular dermatoses were assessed in this prospective observational study. Because benign lesions can closely resemble infectious illnesses, neonatal pustular eruptions are common dermatological problems that occur during the first month of life and often provide diagnostic issues.

Males made up 57.6% of the cases in the current investigation, indicating a male predominance. Previous research on neonatal dermatitis have revealed similar findings. Male preponderance has been regularly reported in a number of neonatal skin condition cohorts, despite the lack of a clear scientific reason. In the first 72 hours following birth, lesions appeared in over half of the newborns.

The physiological adaptability of newborn skin during the early postnatal period is reflected in this observation. Transient pustular eruptions are caused by dynamic changes in immune responses, epidermal maturation, and microbial colonisation during the early newborn period. With 30.5% of patients, erythema toxicum neonatorum was the most frequent diagnosis. It is commonly known that ETN is the most common benign pustular eruption in infants.

Usually appearing in the first few days of life, the lesions go away on their own without any help. The second most frequent diagnosis, accounting for 18.6% of cases, was transient newborn pustular melanosis.

Benign pustular diseases accounted for almost half of all neonatal pustular dermatoses seen in this investigation, along with miliaria pustulosa. Neonatal candidiasis was the most common diagnosis among infectious diseases. Affected neonates frequently had maternal vaginal candidiasis, which supports the idea that vertical transmission occurs following delivery. Infectious pustular dermatoses were also significantly influenced by staphylococcal skin infections and impetigo. These results emphasise the role that prenatal microbial exposure and maternal illnesses play in the pathophysiology of newborn skin diseases.

One important risk factor for infectious pustular dermatoses was found to be low birth weight. Due to their undeveloped immune systems and compromised skin barrier function, low-birth-weight babies are more susceptible to bacterial and fungal infections. Infectious lesions showed a particularly substantial correlation with NICU hospitalisation.

This elevated risk is probably caused by prolonged hospital stays, invasive treatments, and increased exposure to microbes linked to healthcare. Neonatal antibiotic exposure was shown to have the strongest correlation in the study. Infectious pustular dermatoses were significantly more common in newborns exposed to antibiotics. Antibiotic treatment may promote fungal overgrowth, interfere with normal microbial colonisation, and make a person more vulnerable to opportunistic infections.

Current research on newborn infections has reported similar results. Infective pustular dermatoses were also significantly correlated with prolonged rupture of membranes and maternal urinary tract infections. The idea that maternal and perinatal illnesses affect neonatal microbial colonisation and the ensuing risk of skin infection is supported by these findings. Neonatal pustular eruptions are generally benign, as evidenced by the fact that over half of the newborns merely needed comfort and observation.

Crucially, all neonates showed full recovery with no problems or death. These results confirm that, when properly diagnosed and treated, neonatal pustular dermatoses have an outstanding prognosis.

Advantages

·         A design for prospective observation.

·         A thorough evaluation of environmental, neonatal, and maternal factors.

·         Assessment of neonatal pustular diseases, both infectious and benign.

·         Treatment and outcome analysis are included.

Restrictions

·         A single-center investigation.

·         The sample size is moderate.

·         Not every infectious case had microbiological confirmation.

·         There was no multivariate logistic regression.

Clinical Consequences

Antimicrobial exposure and needless examinations can be decreased by identifying distinctive infant pustular dermatoses. Early diagnosis and focused treatment may be facilitated by identifying high-risk neonates, especially those with low birth weight, NICU hospitalisation, and maternal infection. In order to avoid overtreatment and parental concern, it is equally crucial to be aware of benign self-limiting disorders.

The most prevalent neonatal pustular dermatosis was erythema toxicum neonatorum, which was followed by temporary neonatal pustular melanosis. Low birth weight, NICU admission, neonatal antibiotic exposure, protracted rupture of membranes, and maternal urinary tract infection were all strongly linked to infectious pustular dermatoses. The majority of neonatal pustular dermatoses were benign, self-limiting, and simply needed comfort and surveillance. Improved management, less needless antibiotic usage, and improved newborn care can all be achieved through early clinical identification and risk factor assessment.

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