SAN FRANCISCO Iatrogenic injuries to a baby's skin from a stay in the neonatal intensive care unit often get overlooked until parents notice them at home and think they are seeing new injuries, Dr. Ilona J. Frieden said.
"These are very 'busy' babies, covered with monitors, and they're very tiny" babies, she said at a meeting sponsored by Skin Disease Education Foundation. Many things that are used on preterm babies can cause skin injury or scarring, such as tape, electrodes, transcutaneous monitoring devices, adhesives, and cleansers. Phototherapy can sunburn their fragile skin, and infusions and blood draws cause punctures and possible scars.
"A majority of infants who come out of the premature NICU will have some degree of minor skin scarring. You can almost expect it. The more preterm they are, the more likely this is," said Dr. Frieden, professor of dermatology and pediatrics at the University of California, San Francisco.
Later in infancy, after discharge from the hospital, parents may notice what they think is a new lesion. "People get worried this may be a new rash, when in fact, it's a so-called anetoderma of prematurity," she said. These atrophic lesions, usually on the ventral skin, initially can be progressive, and then stabilize.
Another iatrogenic injury seen in preterm infants is halo scalp injurya temporary or permanent alopecia, usually in the occipital area, from pressure on the affected area.
"You would think it would be more common in big, term babies," but halo scalp injury is more common in preterm infants, Dr. Frieden said. "They may just be more susceptible to the pressure."
Providing a dermatologic consult in the NICU has its advantages and disadvantages, she noted.
The young patient has a short history, and you can do a complete exam relatively quickly. Biopsies are easy to do (if needed) because the infants are easy to hold down.
On the other hand, you go to the babies instead of patients coming to you, which involves commute time. Extra hand washing is required. Premature infants can stop breathing when touched, which can be scary for dermatologists. Rashes can be hard to see on such tiny bodies, especially when viewed through plexiglass coverings. You may have no idea what's wrong and feel inadequate. And nurses may be annoyed at your mere presence, she said.
Listen to the nurses, Dr. Frieden advised. "It is their territory. You're only a visitor."
Get permission before you do anything. Don't panic. You probably know more than you think you do, and you can get help if needed. Think in terms of disease categories if you suspect something is more than a benign iatrogenic injury.
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