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Overview of neonatal conditions

Last updated: March 12, 2025

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Neonatal conditions manifest during the first 28 days of life and can affect any organ system. This article includes an overview of neonatal conditions by organ system with additional information on macrosomia, neonatal skin conditions (e.g., erythema toxicum neonatorum, congenital dermal melanocytosis), neonatal hypoglycemia, hematologic conditions (e.g., physiologic anemia of pregnancy, neonatal polycythemia), and infantile colic.

For information about routine newborn care, see “The newborn infant.”

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Macrosomiatoggle arrow icon

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Neonatal skin lesionstoggle arrow icon

Erythema toxicum neonatorum

  • Definition: : a benign, self-limiting rash that appears within the first week of life
  • Etiology: unknown (probable contributing factors: immature sebaceous glands and/or hair follicles)
  • Clinical features
  • Diagnostics
  • Treatment: observation only
  • Prognosis: : typically resolves without complications within 7–14 days

Congenital dermal melanocytosis (Mongolian spot)

  • Definition: benign blue-gray pigmented skin lesion of newborns
  • Neonatal prevalence [2]
    • Asian and Native American: 85–100%
    • African American: > 60%
    • Hispanic: 46–70%
    • White: < 10%
  • Pathophysiology: melanocytes migrating from the neural crest to the epidermis during development become entrapped in the dermis
  • Clinical features
    • Blue-gray pigmented macule (may also be green or brown)
    • Location: most common on the back, also seen on the buttocks, flanks, and shoulders
    • Diameter: typically < 5 cm, may be > 10 cm
  • Diagnostics
    • Based on clinical appearance
    • It is important to document the diagnosis of Mongolian spots, as they may resemble bruises and lead to false suspicions of child abuse.
  • Prognosis: : usually resolves spontaneously during childhood (typically by the age of 10 years) [3]

Congenital melanocytic nevus

  • Definition: a congenital skin lesion caused by the proliferation of melanocytes
  • Epidemiology: 1/20,000 births [4]
  • Clinical features ; [4]
    • Light to darkly pigmented, well-circumscribed macule or patch
    • Often with increased hair growth
    • Vary in size: < 1.5 cm to > 20 cm
    • A nevus larger than 20 cm in size is referred to as a giant congenital melanocytic nevus
  • Treatment: surgical excision or laser ablation (depending on type and size of lesion)
  • Prognosis: large nevi are at risk of degeneration → frequent follow-up

Infantile hemangioma (strawberry hemangioma)

  • Definition: benign capillary vascular tumor of infancy
  • Epidemiology
    • Occurs in 3–10% of infants [5]
    • More commonly affects girls
  • Pathophysiology
  • Clinical features
    • Manifests during the first few days to months of life
    • Progressive presentation; : blanching of skin fine telangiectasias red painless papule or macule (strawberry appearance)
    • Most commonly on head and neck
    • Usually solitary lesions
  • Diagnostics
    • Based on clinical findings
    • The differential diagnosis of cherry angioma is found mostly in adults.
  • Treatment
  • Complications
  • Prognosis
    • Usually good prognosis
    • Spontaneous resolution is common
    • Visual impairment if periorbital hemangioma is left untreated

Others

Some congenital infections may manifest with rashes or other skin conditions and should be differentiated from benign skin lesions in the newborn.

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Neonatal hypoglycemiatoggle arrow icon

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Physiologic anemia of infancytoggle arrow icon

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Neonatal polycythemiatoggle arrow icon

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Infantile colictoggle arrow icon

  • Etiology
    • Unknown
    • Gastrointestinal (e.g., overfeeding or underfeeding, aerophagia, cow's milk intolerance)
    • Biologic (e.g., increased serotonin levels, tobacco exposure, dysfunctional motor regulation related to immaturity)
    • Psychosocial factors (e.g., exposure to stress)
  • Clinical features
    • Otherwise healthy infant with appropriate weight gain
    • Paroxysmal episodes of loud and high pitched crying that often occur at the same time each day (usually in the late afternoon or evening)
    • Hypertonia (e.g., clenched fists, stretched legs) during episodes
    • Infant is not easily consoled
  • Diagnostics: crying that lasts ≥ 3 hours per day, ≥ 3 days per week, for ≥ 3 weeks in an otherwise healthy infant < 3 months
  • Treatment
    • Reassurance
    • Soothing techniques
    • Trial of various feeding techniques
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