Sucking blister

Last updated

Sucking blisters are a cutaneous condition on newborns that is present on their extremities at birth. This is not to be confused with sucking pads, which are similar in appearance. Sucking blisters are due to natural neonatal sucking reflexes on the affected areas in utero. [1] These sucking blisters become present at birth when the sucking movements are very aggressive while in the uterus. [2] These blisters are commonly found on the newborn's arms, fingers, or any body part they are able to suck on. It is a very rare condition, seen in less than 1% of newborns. [3] It is difficult to diagnose because its appearance can be mistaken as other skin conditions. Diagnosis is usually done by eliminating other possible cutaneous conditions. This process of elimination includes examining blood culture, lesions, and inflammatory markers. This skin condition is usually self-inflicted, benign and can heal on its own. Sucking blisters do typically not require medical treatment and disappear within a week. [4] [5]

Contents

Signs and symptoms

A fetus robustly sucking on areas such as forearm, fingers and hands while in utero can cause a blister on those affected areas presenting at birth, with a diameter ranging from 0.5 centimeters to 1.5 centimeters. [6] [7] The blisters commonly happen on one side of the involved area but in some cases, they are on both extremities. [8] However, there is no difference in the severity of the condition with regard to how many extremities the blisters are present on. [7] Continued sucking would cause the blister to rupture so in some cases newborns will present with a denuded skin while others’ blisters stay intact at birth. The fluid inside the blister is clear, yellowish and shows negative results on bacterial cultures. [7] Sucking blister is considered a noninfectious condition and is usually not harmful. [7] [9]

There are limited resources of this skin condition in any textbook about pediatric patients and skin conditions, which explains the unfamiliarity in practice of pediatricians or dermatologists. [10] Providers must determine the diagnosis of sucking blisters based on the information available on the presentation of other congenital blistering conditions to successfully rule them out. Understanding the causes and manifestations of both simple and complex skin damage and conditions will help providers address the issue and provide care. [11] According to its characteristic as a non-serious and self-limiting condition, providers can avoid any unnecessary diagnostic procedures and treatments for the newborns, if it is sucking blister, which can relieve the anxiety for the parents of newborns. [5] [4]

There have also been reports of sucking blisters forming on the lips, which is very uncommon in comparison to the typical locations of blisters on extremities. [12] Treatment for the blisters on this rare location is similar to any other affected area of sucking blister. [12]

Clinical studies and case reports

Case reports on extremities

A newborn who was born to a 26-year-old Caucasian women at the 41st week of gestation was seen with 2 round erosions on the left wrist in the postpartum examination. Both mother and baby were healthy with no history of infection and skin abnormalities. The sucking was even observed during the examination of the affected area. There was no treatment prescribed and the lesion was resolved after several days. [5]

Another newborn who was born to 34-year-old woman via untraumatic natural delivery at her 39th week of gestation was seen with an erosion on her left forearm via examination happening just after birth. No abnormalities were detected during the pregnancy and the mother was healthy. After one week, her lesion was spontaneously healed without any treatment. [13]

Another newborn was detected with a lesion on the left wrist with its diameter of 1.5 centimeters x 1 centimeters. There was no relevant history regarding the mother's or neonate's health condition during gestation to explain the cause of this lesion. Parents of the newborn were frustrated and anxious because their baby got this skin condition right after birth. During examination, the newborn did show sucking of the affected area which helped to ease their parents that the blister happened in the womb. No treatment was given, however, an intervention helped the lesion resolve in six weeks. The intervention involved the use of a dummy for the baby to suck on in between bottle feeds. This was to prevent the baby to suck on their own hand, and allow the wound to stay clean and dry for proper healing. [14]

Rare case report of blister on the lips

A newborn, who was born at the 38th week of gestation, was seen with blisters on both lips during a physical examination happening right after birth. The condition was resolved only after 1 day without any medical intervention. [12] Sucking blisters are not to be confused with leukoedema or sucking pads, as these both are often found on the baby's lips, thumb, or arm, and may be due to the sucking mechanism of the baby. Sucking pads are usually found on the border of the lips, specifically towards the inside of the mouth when looking at the line of the lip. Sucking pads, similar to sucking blister, are also caused by the sucking mechanism of the neonate in utero. However, sucking pads can take three to six months to disappear, whereas sucking blisters may resolve itself within a week. Another similarity with sucking blisters and sucking pads are that they both have bullae with fluids inside and are both benign conditions that may not need treatment. [2]

Demographic data

There was a prospective cohort descriptive study conducted on one thousand newborns born from September 2015 to 2016 in Northeast Thailand to try and identify any types of skin conditions during their first five days post-birth. The most common skin conditions were Mongolian spots, found in 66.7% of the newborns, and sebaceous gland hyperplasia, found in 60.9% of the newborns. The study classified sucking blister in the "miscellaneous cutaneous conditions." Sucking blister was found in 10/1000 newborns which is about 1% of the study population. Other miscellaneous cutaneous conditions in the study were aplasia cutis (0.2%), nevus sebaceous (1.2%), epidermal nevus (0.4%), and bullous impetigo (0.8%). [3]

Diagnosis

Skin conditions can appear and are commonplace during a baby's first months of life, with reports of up to 95% of newborns having some sort of skin finding. [15] With such a high incidence of potential skin conditions on newborns, doctors must be able to differentiate between more severe skin conditions and benign ones. Successfully deciphering the differences between the various types of disease states will depend on how the blisters look, the presence or lack of other blisters, and when they appear on the skin. [16] Sucking blisters are often diagnosed using a process of elimination. [10] Neonatal sucking blisters can be infectious and noninfectious. To check for infection, the process includes examining the neonate's body for signs of inflammation, purulent discharge, or lesions. If there is no presence of those features and the neonate seems generally healthy, it is safe to suggest it is a sucking blister, and not an infection. [17] If there are a lot of lesions, regardless of sepsis present, that can be a sign that the lesions are not sucking blisters. [14] Furthermore, the lack of formation of new blisters also supports the diagnosis of sucking blisters. [18] Due to this skin condition being so rare, this makes it difficult on clinicians to diagnose, especially those who are unfamiliar with sucking blisters specifically. [13] It is helpful for clinicians to be aware of the neonates' skin maturation and physiological process to correctly diagnose and treat skin conditions. [19]

In neonatal populations, sucking blisters are usually caused by the neonate themselves from sucking on their extremities while in the uterus. [4] Neonates can be seen continuously sucking on the affected area outside the uterus. [20] If the child doesn't appear to have any infectious or other skin conditions, the diagnosis of sucking blister is made. [10] Certain characteristics, such as the location of blisters on the upper limbs and the blisters clearing on their own in a few weeks, also support this diagnosis. [13]

A 1963 review estimated that every 1 in 250 children born had sucking blisters, but recent experts in the field think this number is even lower. [13] [9]

Pathophysiology

There are certain primitive reflexes that newborns possess when they are still in the womb. [21] The ones that aid successfully feeding an infant by bottle or on the breast later are rooting and sucking reflex. [22] It is believed that the fetus practices sucking while in the womb, which explains the action of thumb or hand sucking detected by ultrasound, observed from eighteenth to the twenty-fourth weeks of gestation, and fully developed at the 36th week of pregnancy. [23] Frequency of sucking activity will increase toward the end of the pregnancy due to the impact of completed development of taste buds. [23] A study in 1985 about physiology of sucking suggested that failing of initiating normally sucking at the expected time period of the pregnancy or showing any uncoordinated sucking movement might be a sign for an underlying neurologic condition in neonates. [24] There was no case report presenting any correlation of sucking blister and thumbs sucking after birth or any dental abnormalities condition later. [14]

Sucking blister is caused by the fetus forcefully sucking on an accessible area of their body, typically an upper extremity, but potentially toes as well. [6] [18] Neonatal skin is extremely sensitive to this sucking action since the skin barrier has yet to mature. [25] [26] In fact, the dermis does not mature until well into infancy. [26] Because it is not mature, the skin does not have the same protective structure as that of an adult and is more susceptible to physical damage. [16] This damage to the outer layer of the skin results in the formation of a blister. A newborn's skin starts with the vernix caseosa, which looks like a pasty, lipophilic substance. This vernix caseosa is important for newborns as they provide multiple functions such as prevention of water loss, skin hydration, temperature regulation, and assistance with innate immunity. [13]

Besides the damaged outer layer of skin, sucking blisters can also present with fluid buildup. Bursting of this fluid-filled blister results in the red, sensitive area as seen in the image above. [13] Fluid initially collects between the epidermis and dermis in order to protect the deeper tissues and promote healing. [27]

Treatment

Neonatal blistering can be caused by various reasons. If not properly treated or left untreated, they can potentially cause major harm to the baby or even death. Neonatal blistering is most commonly caused by infections, so the presence of blistering should be followed by testing of blister fluid to confirm infection. If there is an infection, the initiation of antimicrobial medications is typically started. [28] In order to ensure the neonate has an infection, a blood sample is taken. In the blood sample, clinicians will look at full blood count, C reactive protein, and blood culture. [20] C-reactive protein levels are typically elevated when there are signs of inflammation. [29] Because sucking blisters result from excessive sucking of the area by the fetus, rather than bacterial, antiviral, or hereditary causes, these blisters can resolve themselves without specific medication treatment within a few days to weeks. [13]

Due to the drastic changes that the neonate experiences going from inside the uterus to the outside world, careful skin management and practices are recommended, especially if there are skin conditions present. [30] The management of a blister will differ based on its clinical features. For the management of closed blisters, moisturizer can be applied after the skin is cleaned with gentle cleanser and warm water. [31] Open blisters may require a wound dressing to cover them, with the dressing type and frequency of changes needed, varying with blister fluid levels. [31] Large blisters should first be cleaned with alcohol and extracted for blister fluid if present; otherwise, gauze and pads can be used to act as a cover over the area as protection against outside sources. [30] Regular bathing of the infant is crucial in preventing the development of an infection at the open blister, and salt can be added to the water to reduce pain associated with the blister. [30]

See also

Related Research Articles

<span class="mw-page-title-main">Blister</span> Small pocket of fluid within the upper layers of the skin

A blister is a small pocket of body fluid within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, touching poison ivy, freezing, chemical exposure or infection. Most blisters are filled with a clear fluid, either serum or plasma. However, blisters can be filled with blood or with pus.

<span class="mw-page-title-main">Harlequin-type ichthyosis</span> Genetic skin disease

Harlequin-type ichthyosis is a genetic disorder that results in thickened skin over nearly the entire body at birth. The skin forms large, diamond/trapezoid/rectangle-shaped plates that are separated by deep cracks. These affect the shape of the eyelids, nose, mouth, and ears and limit movement of the arms and legs. Restricted movement of the chest can lead to breathing difficulties. These plates fall off over several weeks. Other complications can include premature birth, infection, problems with body temperature, and dehydration. The condition is the most severe form of ichthyosis, a group of genetic disorders characterised by scaly skin.

<span class="mw-page-title-main">Chilblains</span> Medical condition

Chilblains, also known as pernio, is a medical condition in which damage occurs to capillary beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue, resulting in redness, itching, inflammation, and possibly blisters.

<span class="mw-page-title-main">Neonatal intensive care unit</span> Intensive care unit specializing in the care of ill or premature newborn infants

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical care area for babies who require close monitoring and intervention, an intermediate care area for infants who are stable but still require specialized care, and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged.

<span class="mw-page-title-main">Bili light</span> Medical therapeutic tool to treat newborn jaundice

A bili light is a light therapy tool to treat newborn jaundice (hyperbilirubinemia). High levels of bilirubin can cause brain damage (kernicterus), leading to cerebral palsy, auditory neuropathy, gaze abnormalities and dental enamel hypoplasia. The therapy uses a blue light (420–470 nm) that converts bilirubin into an (E,Z)-isomer that can be excreted in the urine and feces. Soft goggles are put on the child to reduce eye damage from the high intensity light. The baby is kept naked or only wearing a diaper, and is turned over frequently to expose more of the skin.

<span class="mw-page-title-main">Baby oil</span> Skincare product

Baby oil is, in general terms, an inert oil for the purpose of keeping skin soft and supple. It is often used on babies for the purpose of maintaining "baby-soft" skin, but it is also often used by adults for skincare and massage.

<span class="mw-page-title-main">Erythema toxicum neonatorum</span> Medical condition

Erythema toxicum neonatorum is a common, non-threatening rash in newborns. It appears in 4-70% of newborns within the first week of life, and it typically improves within 1–2 weeks. It only occurs during the newborn period, but may appear slightly later in premature babies. The rash has a variable appearance. It typically includes blotchy red spots, often with overlying firm, yellow-white bumps or pus-filled boils. There may be only a few or many lesions. The lesions can appear almost anywhere on the body, and individual lesions may appear and disappear within hours. There are no other symptoms associated with erythema toxicum neonatorum, and the rash does not have any long-term effects on the skin. Erythema toxicum neonatorum is not harmful and does not require any treatment.

<span class="mw-page-title-main">Fetal surgery</span> Growing branch of maternal-fetal medicine

Fetal surgery also known as antenatal surgery, prenatal surgery, is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.

<span class="mw-page-title-main">Pemphigus vulgaris</span> Medical condition

Pemphigus vulgaris is a rare chronic blistering skin disease and the most common form of pemphigus. Pemphigus was derived from the Greek word pemphix, meaning blister. It is classified as a type II hypersensitivity reaction in which antibodies are formed against desmosomes, components of the skin that function to keep certain layers of skin bound to each other. As desmosomes are attacked, the layers of skin separate and the clinical picture resembles a blister. These blisters are due to acantholysis, or breaking apart of intercellular connections through an autoantibody-mediated response. Over time the condition inevitably progresses without treatment: lesions increase in size and distribution throughout the body, behaving physiologically like a severe burn.

<span class="mw-page-title-main">Gestational pemphigoid</span> Medical condition

Gestational pemphigoid (GP) is a rare autoimmune variant of the skin disease bullous pemphigoid, and first appears in pregnancy. It presents with tense blisters, small bumps, hives and intense itching, usually starting around the navel before spreading to limbs in mid-pregnancy or shortly after delivery. The head, face and mouth are not usually affected.

<span class="mw-page-title-main">Neonatal acne</span> Medical condition

Neonatal acne, also known as acne neonatorum, is an acneiform eruption that occurs in newborns or infants within the first 4-6 weeks of life, and presents with open and closed comedones on the cheeks, chin and forehead.

<span class="mw-page-title-main">Transient neonatal pustular melanosis</span> Medical condition

Transient neonatal pustular melanosis (TNPM), also known as pustular melanosis, is a type of neonatal pustular eruption that is a transient rash common in newborns. It is vesiculopustular rash made up of 1–3 mm fluid-filled lesions that rupture, leaving behind a collarette of scale and a brown macule. The lesions are fragile and with no surrounding erythema. This rash occurs only in the newborn stage, usually appearing a few days after birth, but pigmented macules are sometimes already present at birth. The rash usually fades over three to four weeks but may linger for up to three months after birth. It can occur anywhere on the body, including the palms and soles.

<span class="mw-page-title-main">Blueberry muffin baby</span> Medical condition

Blueberry muffin baby, also known as extramedullary hematopoiesis, describes a newborn baby with multiple purpura, associated with several non-cancerous and cancerous conditions in which extra blood is produced in the skin. The bumps range from one to seven mm, do not blanch and have a tendency to occur on the head, neck and trunk. They often fade by three to six weeks after birth, leaving brownish marks. When due to a cancer, the bumps tend to be fewer, firmer and larger.

Neonatal herpes simplex, or simply neonatal herpes, is a herpes infection in a newborn baby caused by the herpes simplex virus (HSV), mostly as a result of vertical transmission of the HSV from an affected mother to her baby. Types include skin, eye, and mouth herpes (SEM), disseminated herpes (DIS), and central nervous system herpes (CNS). Depending on the type, symptoms vary from a fever to small blisters, irritability, low body temperature, lethargy, breathing difficulty, and a large abdomen due to ascites or large liver. There may be red streaming eyes or no symptoms.

A coma blister, or coma bullae, is a skin lesion or blister that typically arises due to pressure in an individual with impaired consciousness. They vary in size, ranging from 4 to 5 centimeters in diameter, and may appear hemorrhagic or blood filled. Coma blisters are usually found in the extremities and trunk. These types of blisters have been associated with the overdose of central nervous system (CNS) depressants especially barbiturates, but also tricyclic antidepressants, hypnotics, benzodiazepines, opiates, antipsychotics, and alcohol. However, studies have found that coma blisters are not caused by the toxicity of these drugs, but due to hypoxia and external pressure on the comatose individual's skin from being immobilized. Coma blisters have been frequently found on individuals who have overdosed on drugs, but have also been found on individuals with chronic kidney failure, hypercalcemia, diabetic ketoacidosis, and a variety of neurologic conditions. Coma blisters are more frequent in adults and less common among children as demonstrated by the few cases published in literature.

Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) in the setting of fever. Older textbooks may refer to neonatal sepsis as "sepsis neonatorum". Criteria with regards to hemodynamic compromise or respiratory failure are not useful clinically because these symptoms often do not arise in neonates until death is imminent and unpreventable. Neonatal sepsis is divided into two categories: early-onset sepsis (EOS) and late-onset sepsis (LOS). EOS refers to sepsis presenting in the first 7 days of life, with LOS referring to presentation of sepsis after 7 days. Neonatal sepsis is the single most common cause of neonatal death in hospital as well as community in developing country.

Diffuse neonatal hemangiomatosis (DNH) is a potentially fatal disorder where multiple benign (non-cancerous) blood vessel tumors (hemangiomas) are present in the skin and other organs. The mortality rate of diffuse neonatal hemangiomatosis is 50-90%. This disease is normally found in female Caucasian infants. The most common site of internal organ damage, or lesions, is the liver, which can redirect blood away from the heart and cause arteriovenous shunting. This can cause high cardiac output, leading to further complications such as congestive heart failure. This condition affecting the liver is also known as infantile hepatic hemangioma (IHH). Other sites of internal organ damage can include the intestines, nervous system, lungs, and sometimes the skeletal system. Early detection and treatment with steroids results in most newborn babies with this disease remaining healthy, with serious problems developing for some individuals during the hemangioma's growth phase.

Mucous membrane pemphigoid is a rare chronic autoimmune subepithelial blistering disease characterized by erosive lesions of the mucous membranes and skin. It is one of the pemphigoid diseases that can result in scarring.

<span class="mw-page-title-main">Neonatal infection</span> Human disease

Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.

Neonatal pustular eruptions are a group of disorders characterized by various forms of pustulosis seen in the first four weeks of life.

References

  1. ↑ Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  2. 1 2 Thadchanamoorthy V, Thirukumar M, Dayasiri K (October 2020). "Sucking Pads: A Report of Two Newborns". Cureus. 12 (10): e10904. doi: 10.7759/cureus.10904 . PMC   7657316 . PMID   33194471.
  3. 1 2 Techasatian L, Sanaphay V, Paopongsawan P, Schachner LA (2019). "Neonatal Birthmarks: A Prospective Survey in 1000 Neonates". Global Pediatric Health. 6: 2333794X19835668. doi:10.1177/2333794X19835668. PMC   6442070 . PMID   30956996.
  4. 1 2 3 Libow LF, Reinmann JG (July 1998). "Symmetrical erosions in a neonate: a case of neonatal sucking blisters". Cutis. 62 (1): 16–17. PMID   9675526.
  5. 1 2 3 Monteagudo B, León-Muiños E (September 2010). "Neonatal sucking blisters". Indian Pediatrics. 47 (9): 794. PMID   21048267.
  6. 1 2 Rennie JM, Roberton NR (2005). Rennie and Roberton's textbook of neonatology. ISBN   978-0-7020-5242-2. OCLC   830033911.
  7. 1 2 3 4 Murphy WF, Langley AL (December 1963). "Common Bullous Lesions--Presumably Self-Inflicted--Occurring in Utero in the Newborn Infant". Pediatrics. 32 (6): 1099–1101. doi:10.1542/peds.32.6.1099. PMID   14084334. S2CID   11997987.
  8. ↑ Morelli JG (2011), "Diseases of the Neonate", Nelson Textbook of Pediatrics, Elsevier, pp. 2218–2220.e1, doi:10.1016/b978-1-4377-0755-7.00639-4, ISBN   9781437707557 , retrieved 2022-07-26
  9. 1 2 Johr RH, Schachner LA (March 1997). "Neonatal dermatologic challenges". Pediatrics in Review. 18 (3): 86–94. doi:10.1542/pir.18-3-86. PMID   9057476.
  10. 1 2 3 "Picture of the Month—Diagnosis". Archives of Pediatrics & Adolescent Medicine. 161 (6): 608. 2007. doi: 10.1001/archpedi.161.6.608 . ISSN   1072-4710.
  11. ↑ Conlon JD, Drolet BA (August 2004). "Skin lesions in the neonate". Pediatric Clinics of North America. Common Issues and Concerns in the Newborn Nursery, Part II. 51 (4): 863–888. doi:10.1016/j.pcl.2004.03.015. PMID   15275979.
  12. 1 2 3 Aydin M, Hakan N, Zenciroglu A, Demirol HA (October 2013). "A rare location of sucking blister in newborn: the lips". European Journal of Pediatrics. 172 (10): 1423–1424. doi:10.1007/s00431-013-2055-y. PMID   23748984. S2CID   1523464.
  13. 1 2 3 4 5 6 7 Afsar FS, Cun S, Seremet S (November 2019). "Neonatal sucking blister". Dermatology Online Journal. 25 (11). doi: 10.5070/D32511046145 . PMID   32045151. S2CID   210976125.
  14. 1 2 3 Indana NM, Ofoegbu B (2009). "Self harm in utero?" (PDF). Infant Journal. 4 (1): 32.
  15. ↑ Rayala BZ, Morrell DS (February 2017). "Common Skin Conditions in Children: Neonatal Skin Lesions". FP Essentials. 453: 11–17. PMID   28196316.
  16. 1 2 Nischler E, Klausegger A, Hüttner C, Pohla-Gubo G, Diem A, Bauer JW, Hintner H (2010). "Diagnostic pitfalls in newborns and babies with blisters and erosions". Dermatology Research and Practice. 2009: 320403. doi: 10.1155/2009/320403 . PMC   2879860 . PMID   20585476.
  17. ↑ Vella KM, Lara-Corrales I, Rai BK, Kukreti V (November 2020). "Suction Blisters". JAMA Dermatology. 156 (11): 1248. doi:10.1001/jamadermatol.2020.2675. PMID   32876649. S2CID   221465798.
  18. 1 2 Hussain S, Venepally M, Treat JR (February 2013). "Vesicles and pustules in the neonate". Seminars in Perinatology. Dermatology in Infants. 37 (1): 8–15. doi:10.1053/j.semperi.2012.11.005. PMID   23419757.
  19. ↑ Afsar FS (June 2010). "Physiological skin conditions of preterm and term neonates". Clinical and Experimental Dermatology. 35 (4): 346–350. doi:10.1111/j.1365-2230.2009.03562.x. PMID   19758381. S2CID   1255614.
  20. 1 2 Nielsen-Scott A, Goodyear H (October 2019). "Congenital blistering". BMJ. 367: l5287. doi:10.1136/bmj.l5287. PMID   31575524. S2CID   203641152.
  21. ↑ "Looking at Your Newborn: What's Normal (for Parents) - Nemours KidsHealth". kidshealth.org. 2018.
  22. ↑ Woolridge MW (December 1986). "The 'anatomy' of infant sucking". Midwifery. 2 (4): 164–171. doi:10.1016/S0266-6138(86)80041-9. PMID   3643397.
  23. 1 2 Schott JM, Rossor MN (May 2003). "The grasp and other primitive reflexes". Journal of Neurology, Neurosurgery, and Psychiatry. 74 (5): 558–560. doi:10.1136/jnnp.74.5.558. PMC   1738455 . PMID   12700289.
  24. ↑ Smith WL, Erenberg A, Nowak A, Franken EA (August 1985). "Physiology of sucking in the normal term infant using real-time US". Radiology. 156 (2): 379–381. doi:10.1148/radiology.156.2.3892576. PMID   3892576.
  25. ↑ King A, Balaji S, Keswani SG (February 2013). "Biology and function of fetal and pediatric skin". Facial Plastic Surgery Clinics of North America. 21 (1): 1–6. doi:10.1016/j.fsc.2012.10.001. PMC   3654382 . PMID   23369584.
  26. 1 2 Wobser M, Ernestus K, Hamm H (June 2015). "Pediatric dermatohistopathology--histopathology of skin diseases in newborns and infants". Journal der Deutschen Dermatologischen Gesellschaft. 13 (6): 535–548. doi: 10.1111/ddg.12651 . PMID   26018366. S2CID   21535002.
  27. ↑ Uchinuma E, Koganei Y, Shioya N, Yoshizato K (March 1988). "Biological evaluation of burn blister fluid". Annals of Plastic Surgery. 20 (3): 225–230. doi:10.1097/00000637-198803000-00005. PMID   3358612.
  28. ↑ Zhao CY, Murrell DF (August 2016). "Blistering diseases in neonates". Current Opinion in Pediatrics. 28 (4): 500–506. doi:10.1097/MOP.0000000000000381. PMID   27386969. S2CID   2694061.
  29. ↑ Black S, Kushner I, Samols D (November 2004). "C-reactive Protein". The Journal of Biological Chemistry. 279 (47): 48487–48490. doi: 10.1074/jbc.R400025200 . PMID   15337754.
  30. 1 2 3 Johnson E, Hunt R (August 2019). "Infant skin care: updates and recommendations". Current Opinion in Pediatrics. 31 (4): 476–481. doi:10.1097/MOP.0000000000000791. PMID   31188166. S2CID   186206012.
  31. 1 2 Schachner L, Andriessen A, Benjamin L, Bree A, Lechman P, Pinera-Llano A, et al. (November 2021). "The Importance of Skincare for Neonates and Infants: An Algorithm". Journal of Drugs in Dermatology. 20 (11): 1195–1205. doi: 10.36849/JDD.6219 . PMID   34784132. S2CID   244133147.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.