neonatal skin swollen
Introduction
Introduction Due to other factors such as infection, it occurs in the summer, so it is called infection scleredema or summer scleredema. This disease is one of the serious diseases of newborns. It is more common in premature infants or babies with congestive asphyxia and congenital malformation in the first 1-2 weeks after birth. It occurs mostly in the cold season. It can be seen in the summer caused by infectious factors, and the sick children appear. Cold body, hardening of skin and subcutaneous fat and edema
Cause
Cause
The neonatal body surface area is relatively large, the skin is thin and tender, the blood vessels are rich, and it is easy to dissipate heat. Synthetic fat is a unique tissue in the newborn. Its metabolism is the main source of energy for newborns in the cold environment, and the source of energy when starving is white fat. If the ambient temperature in children is too low, too much heat is dissipated, brown fat is easily depleted, and body temperature will drop. The body temperature will not rise when the newborn is seriously infected. In these cases, the subcutaneous fat is easily solidified and hardened, and at the same time, the surrounding capillaries are dilated at low temperature, the permeability is increased, and edema is apt to occur, resulting in hard swelling.
The research on the influence of hypothermia on the human body is still deepening. 1 The peripheral circulation resistance decreases at low body temperature, the blood stagnates, and the tissue is hypoxic. The central blood circulation is reduced, the heart rate is slowed down, and the urine volume is reduced. During the rewarming process, the amount of blood circulation increases, such as the amount of urine does not increase, may cause heart failure, and even pulmonary edema and pulmonary hemorrhage; 2 slow breathing at low body temperature, sometimes apnea, prone to respiratory acidosis, and because Insufficient nutrient intake, resulting in metabolic acidosis, so severe fatty swollen acidosis is also more serious; 3 low body temperature sugar metabolism is not perfect, high blood sugar may occur at the beginning of the disease, but due to increased sugar consumption, followed by hypoglycemia; 4 At low body temperature, hematocrit and blood viscosity increase, thrombocytopenia, and heparin-like substances are also reduced. Various causes can cause coagulopathy and induce disseminated intravascular coagulation (DIC). DIC is more likely to occur due to shock during severe infection.
Examine
an examination
Related inspection
Blood routine temperature measurement skin elasticity examination physical examination of skin diseases
First, clinical manifestations
The disease mainly occurs in the cold winter and cold age groups of newborns, especially premature infants. Clinical manifestations include three major characteristics, namely, body temperature is not rising, skin is swollen and multi-system function damage.
(A) body temperature does not rise: hypothermia is the main performance, the body or limbs are cold, body temperature is often below 35 degrees Celsius, severe cases can be below 30 degrees. Poor body temperature, good heat production and heat-induced failure, help to determine the condition. Those with good heat production temperature> anal temperature, phlegm temperature minus positive temperature difference (between 0-0.9 degrees), most of the disease is short, hard swollen area is small, it is light. Those who have heat-producing fever are warm.
(B) hard skin swelling: including sebum hardening and edema in two cases. The skin becomes hard and the skin can not be lifted against the subcutaneous tissue. In severe cases, the limbs are stiff, unable to move, and touched like a hard rubber. The skin is dark red or pale yellow, may be accompanied by edema, and the finger pressure is concave. Hard swelling is often symmetrical, and the affected parts are lower limbs, buttocks, cheeks, upper limbs, back, abdomen, chest, etc., while eyelids, palms, soles, scrotums, and penis backs are rarely or lacking in subcutaneous fat, so they are not Stiff.
(C) organ function damage: light, organ function is low. Performance is not eating, not crying, low response, slow heart rate or electrocardiogram and blood biochemical abnormalities; severe multiple organ failure, can occur shock, heart failure, DIC, renal failure and pulmonary hemorrhage.
1. Circulatory failure in children with severe hypothermia, especially body temperature microcirculation disorders, such as pale, blemishes, cold limbs, skin pattern, prolonged capillary filling, slow heart rate, slow heart rate, low heart rate and norrhythmia Qi. Severe heart failure, myocardial damage and cardiogenic shock.
2. Acute renal failure This disease is often accompanied by acute renal impairment such as oliguria or even no urine. In severe cases, renal failure occurs.
3. Pulmonary hemorrhage is the extreme performance of severe cases (1) dyspnea and sudden increase of purpura, symptoms are not relieved after oxygenation; (2) rapid increase of wet rales in the lungs; (3) foamy blood from the nose or mouth or endotracheal intubation Liquid; (4) blood gas shows a decrease in PaO2 and an increase in PaCO2. Pulmonary hemorrhage is the most critical clinical symptom and main cause of death in this disease. If it is not timely, it can die in a short time.
4. DIC common skin and mucous membrane spontaneous bleeding, or injection needle hole oozing, may be associated with shock and hemolysis.
(D) other can cause hyperbilirubinemia and promote bilirubin encephalopathy; metabolic disorders such as hypoglycemia, hypocalcemia and metabolic acidosis.
Second, laboratory inspection
Third, diagnosis
1, there is no unified opinion on the diagnosis of scleredema disease, see Table 1. There are also light, moderate and severe according to the extent of hard swelling, general condition, body temperature, and whether there is shock or pulmonary hemorrhage.
2, the diagnosis of skin hard swelling range according to the size of the skin hard swelling, light, medium and heavy three degrees. Mild: Hard swelling range is less than 30%; Moderate: Hard swelling range is 30% to 50%; Severe: Hard swelling range is greater than 50%.
3, hard swollen subcutaneous fat toughness diagnosis degree I degree: subcutaneous fat is slightly hard, skin color is slightly red; II degree: edema is more obvious, subcutaneous fat elasticity is basically disappeared, skin color is slightly dark red; III degree: edema is obvious, The elasticity of the subcutaneous fat disappeared, and the rubbery appearance was hard and the complexion was dark red.
4. The diagnostic criteria for critical scleredema are based on the Trial Program for Critical Case Scoring Method prepared by the Office of Children's First Aid Project of the Ministry of Health of the Ministry of Health.
(1) The temperature of the anus is below 30 °C, and the degree of hard swelling is more than 2 degrees, regardless of the size.
(2) The rectal temperature is below 33 °C, the hard swelling is above 2 degrees, and the range is over 60%.
Anyone who meets one of the above two conditions can be diagnosed as critically ill.
This disease occurs in 7 to 10 days after birth, body temperature does not rise, below 35 ° C, severely below 30 ° C, body temperature (anal temperature) may be lower than body surface temperature ( temperature), skin and subcutaneous tissue Hard swelling, the skin is light red or dark red, severely poor circulation can be pale gray or blue-purple. Hard swelling first appears in the lower limbs, buttocks, cheeks and lower abdomen, then to the upper limbs and the whole body. Sometimes it is hard and not swollen, the skin is pale, like rubber, the scope is limited, only affecting the thighs and buttocks. This often happens in patients with sclered diseases caused by infectious diseases. Severe scleredema can occur with shock, pulmonary hemorrhage, and DIC.
The conditional index is shown in Table 1 according to the criteria discussed at the National Neonatal Group Meeting in 1989.
Diagnosis
Differential diagnosis
The disease sometimes has edema and should be differentiated from neonatal edema. At the same time, it should be differentiated from neonatal subcutaneous gangrene and neonatal subcutaneous fat necrosis.
First, clinical manifestations
The disease mainly occurs in the cold winter and cold age groups of newborns, especially premature infants. Clinical manifestations include three major characteristics, namely, body temperature is not rising, skin is swollen and multi-system function damage.
(A) body temperature does not rise: hypothermia is the main performance, the body or limbs are cold, body temperature is often below 35 degrees Celsius, severe cases can be below 30 degrees. Poor body temperature, good heat production and heat-induced failure, help to determine the condition. Those with good heat production temperature> anal temperature, phlegm temperature minus positive temperature difference (between 0-0.9 degrees), most of the disease is short, hard swollen area is small, it is light. Those who have heat-producing fever are warm.
(B) hard skin swelling: including sebum hardening and edema in two cases. The skin becomes hard and the skin can not be lifted against the subcutaneous tissue. In severe cases, the limbs are stiff, unable to move, and touched like a hard rubber. The skin is dark red or pale yellow, may be accompanied by edema, and the finger pressure is concave. Hard swelling is often symmetrical, and the affected parts are lower limbs, buttocks, cheeks, upper limbs, back, abdomen, chest, etc., while eyelids, palms, soles, scrotums, and penis backs are rarely or lacking in subcutaneous fat, so they are not Stiff.
(C) organ function damage: light, organ function is low. Performance is not eating, not crying, low response, slow heart rate or electrocardiogram and blood biochemical abnormalities; severe multiple organ failure, can occur shock, heart failure, DIC, renal failure and pulmonary hemorrhage.
1. Circulatory failure in children with severe hypothermia, especially body temperature microcirculation disorders, such as pale, blemishes, cold limbs, skin pattern, prolonged capillary filling, slow heart rate, slow heart rate, low heart rate and norrhythmia Qi. Severe heart failure, myocardial damage and cardiogenic shock.
2. Acute renal failure This disease is often accompanied by acute renal impairment such as oliguria or even no urine. In severe cases, renal failure occurs.
3. Pulmonary hemorrhage is the extreme performance of severe cases (1) dyspnea and sudden increase of purpura, symptoms are not relieved after oxygenation; (2) rapid increase of wet rales in the lungs; (3) foamy blood from the nose or mouth or endotracheal intubation Liquid; (4) blood gas shows a decrease in PaO2 and an increase in PaCO2. Pulmonary hemorrhage is the most critical clinical symptom and main cause of death in this disease. If it is not timely, it can die in a short time.
4. DIC common skin and mucous membrane spontaneous bleeding, or injection needle hole oozing, may be associated with shock and hemolysis.
(D) other can cause hyperbilirubinemia and promote bilirubin encephalopathy; metabolic disorders such as hypoglycemia, hypocalcemia and metabolic acidosis.
Second, laboratory inspection
Third, diagnosis
1, there is no unified opinion on the diagnosis of scleredema disease, see Table 1. There are also light, moderate and severe according to the extent of hard swelling, general condition, body temperature, and whether there is shock or pulmonary hemorrhage.
2, the diagnosis of skin hard swelling range according to the size of the skin hard swelling, light, medium and heavy three degrees. Mild: Hard swelling range is less than 30%; Moderate: Hard swelling range is 30% to 50%; Severe: Hard swelling range is greater than 50%.
3, hard swollen subcutaneous fat toughness diagnosis degree I degree: subcutaneous fat is slightly hard, skin color is slightly red; II degree: edema is more obvious, subcutaneous fat elasticity is basically disappeared, skin color is slightly dark red; III degree: edema is obvious, The elasticity of the subcutaneous fat disappeared, and the rubbery appearance was hard and the complexion was dark red.
4. The diagnostic criteria for critical scleredema are based on the Trial Program for Critical Case Scoring Method prepared by the Office of Children's First Aid Project of the Ministry of Health of the Ministry of Health.
(1) The temperature of the anus is below 30 °C, and the degree of hard swelling is more than 2 degrees, regardless of the size.
(2) The rectal temperature is below 33 °C, the hard swelling is above 2 degrees, and the range is over 60%.
Anyone who meets one of the above two conditions can be diagnosed as critically ill.
This disease occurs in 7 to 10 days after birth, body temperature does not rise, below 35 ° C, severely below 30 ° C, body temperature (anal temperature) may be lower than body surface temperature ( temperature), skin and subcutaneous tissue Hard swelling, the skin is light red or dark red, severely poor circulation can be pale gray or blue-purple. Hard swelling first appears in the lower limbs, buttocks, cheeks and lower abdomen, then to the upper limbs and the whole body. Sometimes it is hard and not swollen, the skin is pale, like rubber, the scope is limited, only affecting the thighs and buttocks. This often happens in patients with sclered diseases caused by infectious diseases. Severe scleredema can occur with shock, pulmonary hemorrhage, and DIC.
The conditional index is shown in Table 1 according to the criteria discussed at the National Neonatal Group Meeting in 1989.
Neonatal scleredema
Mild hard swelling range * body temperature anal-sputum temperature difference organ function change
Light 35°C positive value or no mild function
20 to 50%
Weight >50%
Estimation of the area of the body: 20% of the head and neck, 18% of the upper limbs, 14% of the chest and abdomen, 14% of the back and lumbosacral region, 8% of the buttocks, and 26% of the lower limbs.
