Management

1) Erythema Toxicum Neonatorum

The condition resolves spontaneously over the first few weeks of life and no treatment is needed.

2) Transient Pustular Melanosis

The pigmented macules fade spontaneously over 2-3 weeks and no treatment is needed.

3) Milia

The condition resolves spontaneously over the first few months of life and no treatment is needed.

4) Harlequin colour change

The condition resolves spontaneously but may continue for up to three weeks. No treatment is necessary

5) Seborrhoeic Dermatitis

NICE recommendations ¹²

As the condition is self-limiting, reassurance should be the first-line treatment.

Regular washing of the scalp with baby shampoo (or emollient) and gentle bushing will help to loosen scalp scales.

Napkin scales can be loosened by bathing the child once a day using a emollient or soap substitute.

If resistant to treatment a topical imidazole cream can be used until symptoms resolve. Specialist advice should be sought if requiring longer than 4 weeks of treatment.

6) Mongolian Blue Spot

These lesions tend to fade over several years but may not completely disappear.

They can be mistaken for bruises and may present to the ED with child safeguarding concerns. If in doubt, check the Red Book or primary care sources (GP/Health Visitor) to confirm present at birth. If concerns, refer to paediatrics

All patients who are clinically jaundice should have a total serum bilirubin checked and this should be compared to the NICE treatment threshold graphs.

If there is no evidence of pathological jaundice the child can be discharge home with advice to return if they are unwell or the jaundice level is increasing.

If the measured level is above the threshold the patient should be referred for phototherapy and investigation.

NB: The threshold graphs have two treatment lines: one for “phototherapy” and another for “exchange transfusion”. However, exchange transfusion should not be attempted in an ED setting and many paediatrics units will favour intensive phototherapy unless there is evidence of kernicterus.

Unfortunately there is no evidence for the treatment threshold levels and this is based upon expert opinion.

Phototherapy involves placing the child under a lamp emitting light in the blue spectrum. This converts bilirubin in the skin to a form that can be excreted in the urine.

Phototherapy has been shown to be significantly reduce hyperbilirubinaemia when compared to no treatment in both term^14-19 and preterm babies¹⁴, ^20-24. NNT to prevent one exchange transfusion was ¹⁰ and ¹⁶ respectively¹³