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Iatrogenic Cutaneous Injuries in the Neonate

Aryeh Metzker, MD; Sarah Brenner, MD; Paul Merlob, MD
Arch Dermatol. 1999;135(6):697-703. doi:10.1001/archderm.135.6.697.
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Published online

Background  Iatrogenic cutaneous injuries of the neonate have decreased in number in the last 30 years because of changes in the medical procedures during the prenatal, perinatal, and postnatal periods.

Observations  The emergence of such cutaneous injuries derived from the use of instruments, blunt and sharp, from manual manipulations, from medications, and from hesitation or abstaining from intervention.

Conclusion  The dermatologist, unfamiliar with handling of neonates in the nursery, should be capable of recognizing and dealing with these phenomena when encountered in the acute stage or with their residue.

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Figures

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Figure 1.

A deep dimplelike scar (0.4×0.2 cm) on the abdomen of a newborn, caused by amniocentesis.

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Figure 2.

A gaping wound on the lower part of the neck caused by injection of contrast material during an amniography trial.

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Figure 3.

Chest x-ray film showing the contrast material injected into the neck of the fetus in Figure 2.

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Figure 4.

One-day-old newborn with toxic epidermal necrolysis syndrome whose mother had had amniography 10 days earlier.

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Figure 5.

Ulcer with granulation on a newborn's scalp, 3 days after monitoring during labor.

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Figure 6.

Scars on the scalp after numerous applications of monitoring electrodes during labor.

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Figure 7.

Lacerations on a newborn's scalp caused by misplaced scissors during amniotomy.

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Figure 8.

An elongated, edematous scalp with an extensive caput succedaneum a few hours after delivery.

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Figure 9.

Deep laceration on the shoulder that occurred during cesarean section.

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Figure 10.

Annular arrangement of suction blisters after application of vacuum extraction; mild ecchymoses are seen in the surrounding skin.

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Figure 11.

Edema and ecchymosis of the left arm after breech presentation delivery.

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Figure 12.

Hematoma of the scrotum that occurred after traumatic breech delivery.

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Figure 13.

Deep tear of labia majora of an infant's vulva during breech delivery.

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Figure 14.

A bowlike fresh ecchymosis on a newborn's temple after forceps delivery.

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Figure 15.

Depression of the frontal bone, right side (arrow), at the moment of delivery caused by a forceful forceps application.

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Figure 16.

X-ray film of the skull demonstrating depression of the right frontal bone (arrow) in the newborn in Figure 15.

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Figure 17.

Bilateral subsiding orbital ecchymoses in a newborn a few days old resulting from hemorrhage in the base of the skull after forceful forceps delivery.

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Figure 18.

Erythema and scaling on the ankle caused by friction because of a tightly applied identification tag.

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Figure 19.

Two tiny lesions of necrosis after local contact with potassium permanganate crystals.

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Figure 20.

Second-degree chemical burn after prolonged contact with alcohol on a newborn's back.

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Figure 21.

Third-degree burn on the upper part of the back of a newborn after too close exposure to a heating radiator.

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Figure 22.

Superficial scar on a newborn's chest after localized combustion from warm PO2 monitoring electrode.

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Figure 23.

Circumscribed erosion on the tip of the nose after continuous friction in a prone-positioned neonate.

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Figure 24.

Localized inflammation of the heel around a small deep laceration after blood sampling.

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Figure 25.

An ulcer and surrounding necrosis after "cutdown" procedure on the ankle of a newborn.

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Figure 26.

Calcified remnants of intravenous calcium gluconate injection through a scalp vein.

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Figure 27.

A red swelling with an underlying sacral abscess (arrow) that developed days after a lumbar puncture.

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Figure 28.

Cold panniculitis showing a shiny swelling, hardening, and inflammation of the cheek after an ice-bag technique applied for supraventricular tachycardia.

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Figure 29.

Hardening, erythematous, and warm plaque representing subcutaneous fat necrosis in a 2-week-old newborn who suffered respiratory distress at birth.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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