School of Nursing

5th Floor Fisher Hall
600 Forbes Avenue
Pittsburgh, PA 15282
Email: nursing@duq.edu
Phone: 412.396.6550
Fax: 412.396.6346

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Skin

Expected Findings:
  • Skin reddish in color, smooth
    and puffy at birth

  • At 24 - 36 hours of age, skin flaky, dry and pink in color

  • Edema around eyes, feet, and genitals

  • Turgor good with quick recoil

  • Cord with one vein and two arteries

  • Cord clamp tight and cord drying
photo of expected findings on skin
Photo used with permission*
  • Hair silky and soft with individual strands

  • Nipples present and in expected locations

  • Nails to end of fingers and often extend slightly beyond

  • Vernix caseosa - The white, cheesy substance covering the newborn's body. Often present only in the skin folds.

  • Lanugo - Fine downy body hair usually distributed over shoulders, sacral area, and back of newborns. Usually disappears before birth or shortly after birth.

Common variations:
ACROCYANOSIS
The result of sluggish peripheral circulation.
photo of baby with acrocyanosis
Photo used with permission*
MONGOLIAN SPOTS 
Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of African-American or Asian descent. Not malignant. Resolves in time.
photo of baby with Mongolian spots
Photo used with permission*

MOTTLING
Generalized red and white discoloration of skin of chilled infants with fair complexion.

photo of baby with mottling
Photo used with permission*

PHYSIOLOGICJAUNDICE
Hyperbilirubinemia not associated with hemolytic disease or other pathology in the newborn. Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. Bilirubin may reach 6 to 10 mg/dl and resolve in 5 to 7 days.
photo of baby with physiologic jaundice
Photo used with permission*
MILIA
Tiny white papules (plugged sebaceous glands) located over nose, cheek, and chin.
photo of baby with milia
Photo used with permission*
ERYTHEMA TOXICUM photo of baby with erythema toxicum
Photo used with permission*
  • Petechiae/ bruises over presenting part.
    Petechiae: Pinpoint, flat hemorrhages often visualized on head, face, and chest. Associated with rapid onset of pressure followed by immediate release of pressure during birthing process. 
    Bruises/Ecchymoses: Larger than petechia, hemorrhagic areas associated with rapid delivery or breech birth.
  • Skin tags usually around ears or digits (tied off)
  • Harlequin coloring - The color of the newborn's body appears to be half red and half pale. This condition is transitory and usually occurs with lusty crying. Harlequin Coloring may be associated with to an immature vasomotor reflex system.
Signs of potential distress or deviations from expected findings:
  • Jaundice (within 24 hours of birth) - Unconjugated bilirubin circulating in the blood stream that is deposited in the skin. Skin color may range from yellow to orange to greenish hues.
  • General cyanosis
  • Circumoral cyanosis between feedings
  • Petechiae or ecchymoses other than on presenting part
  • All rashes with exception of
    erythema toxicum
  • Pigmented nevi
  • Yellow vernix
  • Hemangioma
  • Pallor
  • Forceps marks

photo of baby with forcep marks
Photo used with permission*

* Photo used with permission of Mead Johnson (1978). Variations and Minor Departures in Infants. Nutritional Division Mead Johnson & company, Evansville, Indiana.