Sclerema Neonatorum
Sclerema neonatorum manifests itself as an induration and stiffening of the skin in new-born children. The disease may be congenital, but when this is the case the children are usually still-born. More frequently the trouble develops within the first few days of life.
The skin of the legs is usually first attacked, and successive portions of the integument are affected till the whole surface has become involved. Occasionally the disease begins in the cheeks and spreads downward. At first the skin is of a whitish, waxy appearance, and feels thick when pinched between the fingers : but as the malady
advances a livid hue is developed, and the skin becomes adherent, so that it can no longer be picked up.
When the process is fully developed the child lies rigid, with no perceptible motion save that due to its feeble respirations. The joints are not readily flexed, and the child may be picked up by the legs and held out horizontally; the jaws are so stiff that nursing is impossible. The pulse decreases to 60 per minute : the respirations are slow and shallow ; and the temperature is below the normal by two or three degrees : under such conditions life cannot long persist, and is generally extinguished in five or six days.
Sclerema Neonatorum was until the time of Parrot confused with oedema, which may occur in the new-born from various causes. Parrot makes the essence of the disease a drying up or desiccation of the skin ; he denies that
there is a true sclerosis. Langer attributes the stiffness of the integument to solidification of the subcutaneous fat ; in infants the fat becomes solid at 89.6° F.. while in adults this occurs at a temperature lower than 32°F. If by
any depressing cause the infants temperature is sufficiently reduced, the fat solidifies, and sclerema neonatorum is the result.
Etiology: — The disease is most common in those born prematurely. Any conditions which depress the general health, such as congenital heart affections, bronchitis, diarrhoea, exposure to cold. etc.. seem to act as predisposing causes.
Diagnosis: — Sclerema neonatorum is distinguished from oedema by the fact that the skin is stiff and unyielding, and that there is no pitting on pressure. (For the differential diagnosis between sclerema neonatorum and scleroderma the reader is referred to the article on the latter subject.)
Prognosis: — The disease is nearly always fatal. Encouragement is. however, offered by the few cases that have recovered.
Treatment: — An effort should be made to bring the temperature of the child to the normal by enveloping it in cotton wool, or, better, by placing it in incubator. As nursing is impossible, nourishment must be maintained by
other methods. Milk with brandy may be administered per rectum or by means of a catheter passed into the stomach through the nose.
Source: —
An American text-book of the diseases of children by Starr, Louis, 1849-1925; Westcott, Thompson S. (Thompson Seiser), 1862-1933
Published 1900
Publisher Philadelphia, W.B. Saunders
Pages 1352
Language English
Digitizing sponsor Open Knowledge Commons
Book contributor Columbia University Libraries
Desiccated Thyroid USP and treatment of Sclerema Neonatorum .... 1128
Bolognini has with success used ThyrMidta in a case of Sclerema neonatorum. The child, who was born somewhat prematurely, showed the second day after birth Sclerema on her forehead and her cheeks where the skin was yellowish, waxy consistency, and impossible to lift it up.
Despite the use of different media deteriorated condition quickly; Sclerema raced across the arms and legs and heart rate were bad. Child was treated with 4 Thyreoideatablets dissolved in milk a day, and then improved the child's condition quickly; Three and a half tablet a day was used, which is equivalent to one gram fresh thyroid gland. This relatively high dose was well tolerated; only the last days there came some irregularity of pulse. (Semaine with. 1898, 52.)
Thyreoidin og Skierema neonatorum .... 1128
Bolognini har med Held anvendt ThyrMidta i et Tilfælde af Skierema neonatorum. Barnet, der var kommet noget for tidligt, viste anden Dag efter Fødslen Skierem i Panden og paa Kinderne, hvor Huden var gullig, af voksagtig Konsistens, medens det var umuligt at løfte den op i Folder.
Trods Anvendelse af forskellige Midler forværredes Tilstanden hurtigt; Skleremet bredte sig ud over Arme og Ben og Pulsen blev daarlig. Der anvendtes da 4 Thyreoideatablet[ter] i Mælk om Dagen og herunder bedredes Tilstanden hurtigt; ialt brugtes mellem tre og en halv Tablet, svarende til eet Gram frisk Kirtel. Denne relativt høje Dosis taaltes godt; kun de sidste Dage kom der nogen Uregelmæssighed af Pulsen. (Semaine med. 1898, 52.)
Source:
Ugeskrift for læger by Almindelige danske lægeforening
Published 1898
Volume 5
Publisher C.A. Reitzel
Year 1898
Pages 1614
Language Danish
Book from the collections of Harvard University
