2. Kingston ME, Mackey D. Skin clues in the diagnosis oflife-threatening infections. Rev Infect Dis 1986;8:1–11.

3. Murray HW, Tuazon CU, Sheagren JN. Staphylococcalsepticemia and disseminated intravascular coagulation:Staphylococcus aureus endocarditis mimicking meningo-coccemia. Arch Intern Med 1977;137:844–847.

4. Cherry JD, Thareen R. Cutaneous manifestations ofsystemic infections. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Textbook of pediatricinfectious diseases, 6th edn. Philadelphia: SaundersElsevier, 2009:760.

5. Gonzalez BE, Martinez-Aguilar G, Hulten KG et al.Severe staphylococcal sepsis in adolescents in the era ofcommunity-acquired methicillin-resistant Staphylococcusaureus. Pediatrics 2005;115:642–648.

RATI SANTHAKUMAR,M.B.B.S., D.N.B.*DAVID PUDUKADAN, M.B.B.S., M.D.�JOHNY VINCENT, M.B.B.S., M.D.*BABURAJ PARAMESWARAN, M.B.B.S., M.D.�Departments of *Pediatrics, �Dermatology, and�Medicine, Jubilee Mission Medical College, East Fort,Thrissur, Kerala, India

PREVALENCE OF CUTANEOUS FINDINGS

IN SPANISH NEONATES AND

RELATIONSHIPS TO OBSTETRIC AND

PARENTAL FACTORS

Abstract: Two hundred forty-seven healthy new-borns were investigated in a prospective cohortdescriptive study. Information on phenotype andobstetric and parental history was collected. A positiveassociation was found between erythema toxicumneonatorum and season of birth (spring and summer),whereas parental history of any skin disease wasrelated to a lower frequency of this eruption.

INTRODUCTION

Although several studies have documented cutaneousfindings in neonates and varies in different racial groups(1–5), this is the first to characterize skin findings inSpanish newborns.

Our objectives were to describe the prevalence ofphysiologic and pathologic skin findings in newbornsand to estimate their association with various obstetricand maternal factors.

METHODS

In a prospective-cohort descriptive study, 247 healthynewborns delivered between October 2009 and July2010 were recruited. Information on phenotype andobstetric and parental history was collected. The samedermatologist examined each of the babies once onday 2 of birth.

The sample was described using relative frequenciesof categories for nominal variables and mean ±standard deviation for the scale variables after testingfor normality of distribution. Comparisons were madeusing the Pearson chi-square test or the Fisherexact test for nominal variables and the t-test forscale variables. All tests were performed at a 0.05bilateral significance level, and calculations were per-formed using the statistical package SPSS 17.0.3 forWindows (SPSS Inc., Chicago, IL, USA).

RESULTS

Of the 247 newborns, 95.5%wereCaucasian, and 92.3%were phototype 2 or 3. Fifty (20.2%) referred to aparental history of any skin disease; the most frequentwas atopic dermatitis (5.7%), followed by acne (4%) andpsoriasis (3.6%). Two hundred thirty-eight neonates(96%) had one or more cutaneous findings. The lesionsare identified and their frequencies shown in Table 1.

The frequency ofmilia, gingival and palatal cysts, andsebaceous hyperplasia did not vary significantly accord-ing to sex, gestational age, ormodeofdelivery.Therewas

TABLE 1. Frequency of Cutaneous Lesions Occurring in 247Newborns

Skin disorder n (%)

Sebaceous hyperplasia 110 (44.5)Desquamation 92 (37.2)Salmon patch 81 (32.8)Milia 73 (29.6)Hypertrichosis 78 (31.6)Gingival and palatal cysts 73 (29.6)Caput succedaneum 46 (18.6)Erythema toxicum 51 (20.6)Mongolian spots 47 (19)Cephalohematoma 7 (2.8)Congenital melanocytic nevi 5 (2)Hemangioma 2 (0.8)Hematom 2 (0.8)Ulnar polydactyly 2 (0.8)Miliaria 1 (0.4)Natal teeth 1 (0.4)Neonatal adnexal polyp 1 (0.4)Port wine stain 1 (0.4)Sacral dimple 1 (0.4)Suction blisters 1 (0.4)Transient neonatal pustular melanosis 1 (0.4)

Address correspondence to David Pudukadan, M.B.B.S.,M.D., TC-2 ⁄ 268, Near Girija Theatre, Shornur Road, Thrissur,Kerala 680022, India, or e-mail: davidpudukadan@gmail.com.

232 Pediatric Dermatology Vol. 29 No. 2 March ⁄April 2012

no significant difference in the incidence of salmon patchin terms of maternal age, weight, height, or gestationalage. In addition, the frequency of mongolian spot andhypertrichosis did not vary significantly according togestational age, birth height, or weight, whereas des-quamation was associated with greater gestational age(p = 0.01).

A positive association was found between erythematoxicum neonatorum (ETN) and season of birth (springand summer, p = 0.01). Parental history of any skindisease was related to a lower frequency of this eruption(p = 0.04).This findingwasmore frequent in the eutocicdelivery group (p = 0.07) and was not present in anyof the 12 newborns with a maternal history of atopiceczema.

DISCUSSION

The findings of our study are not completely comparablewith those of other previous reports, in which newbornshad other phenotypic features and were hospitalized orexamined in the first 10 days of life (1–5).

The most frequent parental skin disease was atopicdermatitis, whose associationwithETNhas been studiedwithout finding any relationship between them (5), as inour study. This eruption has been associated withcesarean (3) and vaginal delivery (4), whereas we foundbirth in the hotter seasons to be a predisposing factor;similar results have been described previously (4).

The newborns were examined only once on day 2after birth, which limits not only the detection of somecases of ETN but also the presence of hemangiomas,which may appear later. Hence, further prospectivestudies with repeated examinations are recommended.

REFERENCES

1. Ferahbas A, Utas S, Akcakus M et al. Prevalence of cuta-neous findings in hospitalized neonates: a prospectiveobservational study. Pediatr Dermatol 2009;26:139–142.

2. Moosavi Z, Hosseini T. One-year survey of cutaneouslesions in 1000 consecutive Iranian newborns. PediatrDermatol 2006;23:61–63.

3. Gokdemir G, Erdogan HK, Koslu A et al. Cutaneouslesions in Turkish neonates born in a teaching hospital.Indian J Dermatol Venereol Leprol 2009;75:638.

4. Liu C, Feng J, Qu R et al. Epidemiologic study of thepredisposing factors in erythema toxicum neonatorum.Dermatology 2005;210:269–272.

5. Boccardi D, Menni S, Ferraroni M et al. Birthmarks andtransient skin lesions in newborns and their relationship tomaternal factors: a preliminary report from northern Italy.Dermatology 2007;215:53–58.

CRISTINA RODRIGUEZ-GARCIA, M.D.*CRISTOBALINA RODRIGUEZ, Ph.D., M.D.�ROSALBA SANCHEZ, Ph.D., M.D.*SORAHAYA GONZALEZ-HERNANDEZ, M.D.*NURIA PEREZ-ROBAYNA, M.D.*FRANCISCO GUIMERA, Ph.D., M.D.*ARMANDOAGUIRRE-JAIME, Math.D., M.Sc.,D.Sc.�Departments of *Dermatology, �Preventive Medicine,Hospital Universitario de Canarias, �Investigation Unit,Hospital Universitario NS Candelaria, University of LaLaguna, La Laguna, Tenerife, Spain

Address correspondence to Cristina Rodrıguez-Garcıa, M.D.,Department of Dermatology, Hospital Universitario de Canarias,University of La Laguna, La Laguna 38320, Tenerife (CanaryIslands), Spain, or e-mail: cristina_r_g@hotmail.com.

Brief Reports 233