(Edema of the new-born)
This hardening of the skin of the new-born from subcutaneous edema is very rare. It begins in the lower extremities usually before the third day of life but it may show in the prematurely born at birth. The legs are cold, livid and swollen and the condition usually spreads up to the thighs and genitals, may appear on the hands and arms, and in rare cases becomes general. Like other dropsical conditions the swelling is worse in the most dependent parts as the posterior portions of the calves and thighs. The surface pits on pressure although to accomplish this, long pressure may be necessary if the skin is very doughy. However, the skin can be pinched up and the marble-like hardness of sclerema is absent. The bodily temperature is low and the respiration and pulse are slow. The child is too drowsy to nurse and a fatal end may ensue in a few days without further visible complications. Reactions may occasionally present high fever with an icteric hue of the skin instead of the typical livid color of fatal cases.
Etiology and Pathology. – Predisposing causes are those noted in sclerema with the accent on premature birth. The constant pathological finding consists of an effusion of yellow serum into the subcutanous tissue.
Diagnosis. – Both sclerema and edema of the new born occur at an age which should suffice to tell them from other indurations of the skin. This is especially true of scleroderma which has never been recorded before the second year of life. Sclerema is more general, little influenced by gravity, with a denser skin which is usually attacked to the parts beneath and does not pit on pressure. The stiffness and inflexibility of the face and body are pronounced. Edema is apt to be aggravated in or limited to the more dependent parts; it is not so dense, nor attached to the parts beneath, seldom markedly immovable, and usually pits on pressure.
Prognosis and Treatment. – The mortality is from 80 to 90 per cent. Only partial cases recover. The treatment is practically identical with that of sclerema.