Pharmaceutical preparations. A review of drugs commonly used during the neonatal period

Certified nurse-midwives, whose responsibility includes care of the newborn in the first days of life, should be well versed in the commonly used pharmaceutical preparations in the neonatal period. This article reviews therapeutic uses and the pharmacodynamics of vitamin K, as well as the neonatal eye preparations for prophylaxis of infections (silver nitrate, tetracycline, and erythromycin ophthalmic ointments). Preparations used in caring for the umbilical cord, as well as the commonly prescribed antibiotics ampicillin and gentamicin, are discussed. The narcotic antagonist naloxone is also reviewed, along with commonly used medications for colic and thrush. The etiology and clinical conditions that require the application of these medications are considered.

[Intestinal excretion of nystatin during and after oral administration to newborn infants at risk]

The concentrations of nystatin excreted with faeces during and after oral application of 3 x 150,000 IU/d, either continuously for 14-21 days or every second day were determined in 42 newborns at risk by means of a bioassay (agar diffusion test). Results indicate that nystatin is distributed heterogeneously in the gastrointestinal tract. The excretion occurs discontinuously. 24 to 48 h after beginning of therapy there were effective concentrations of nystatin in the faeces. The daily application of 3 x 150,000 IU nystatin is recommended.

Effect of oxyquinoline ointment on diaper dermatitis

The effectiveness of oxyquinoline ointment for diaper dermatitis was tested in a randomized double-blind trial. Compared to a combined control treatment group using Desitin or A & D ointment, use of oxyquinoline ointment significantly improved rash.

Anaphylaxis to cutaneous exposure to milk protein in a diaper rash ointment

A 12-month-old boy, with a strong history of cow's milk allergy, developed two episodes of anaphylaxis following cutaneous application of a casein containing ointment to an inflamed diaper area. RAST testing showed a significant elevation in specific IgE antibodies to milk and milk proteins. This experience suggests that children who are highly sensitive to milk may have severe allergic reactions on cutaneous exposure to milk or milk products.

Comparative and non-comparative studies of the efficacy and tolerance of tioconazole cream 1% versus another imidazole and/or placebo in neonates and infants with candidal diaper rash and/or impetigo

Eleven open multicentre studies were conducted to evaluate the efficacy of tioconazole cream 1% as a treatment for diaper rash with or without fungal (Candida) involvement, or impetigo in neonates and infants. In the dermal candidiasis/diaper rash group, 320 patients had either tioconazole (n = 220), a comparative imidazole (n = 43), or vehicle cream (n = 57) applied to the affected area twice daily. Twenty-one impetigo patients had only tioconazole cream 1% applied three times daily to lesions. The overall cure rate (patients with both clinical and mycological cure) at the end of treatment for tioconazole treated patients was 78%, for the comparative imidazole group it was 76% and for vehicle cream it was 39%. At the long-term follow-up evaluation approximately 6 weeks after treatment for patients with diaper rash, the overall cure rate was about the same in both tioconazole- and comparative imidazole-treated patients (87% and 90%, respectively), and 14% in patients using vehicle cream. Side-effects were coincident with disease symptoms and consisted primarily of erythema localized to the treatment area; they occurred in 5.4% (13/241) of the patients who received tioconazole and in 21% (9/43) of the patients who received comparative imidazole (econazole or miconazole). No side-effects were reported in this open study for the 57 patients who used vehicle cream. The results of these studies show that tioconazole cream 1% is safe and effective for the treatment of neonates and infants with dermal candidiasis, diaper rash and impetigo.

[Gluteal granuloma in an infant]

This report deals with a 5-month-old infant who at the age of 2 months was treated with topical fluorinated steroids for dermatitis in the diaper area. The treatment was continued for about 2 months. Some weeks later, multiple oval and round dark brown nodules developed in the inguinogenital areas. Histologic examination of these lesions revealed intense granulomatous infiltration in the upper dermis that consisted of lymphocytes, neutrophilic and eosinophilic granulocytes, and histiocytes. After steroid therapy was discontinued, the nodules slowly disappeared.

Corn starch, Candida albicans, and diaper rash

The growth of Candida albicans experimentally inoculated onto the skin of human volunteers was not enhanced by the addition of either cornstarch powder or talcum powder. Sufficient nutrients for growth of C. albicans exist on human skin, provided sufficient moisture is present. Cornstarch and talc powders were shown to minimize frictional injury experimentally induced in human volunteers. These studies indicate that cornstarch and talc powders do not enhance the growth of yeasts on human skin and do provide protection against frictional injury.

[Recommendations for local therapy of common dermatoses in children]

Recommendations for topical dermatologic therapy of the most common skin diseases in infancy and childhood are given with tabular summaries. They are concerned with diaper dermatitis, seborrhoeic dermatitis, atopic dermatitis, scabies and pediculosis. Special attention is given to topical steroid therapy in seborrhoeic and atopic dermatitis and to the possible neurotoxic side-effects of Lindan, the most effective substance against scabies and pediculosis.

Metabolic alkalosis secondary to baking soda treatment of a diaper rash

A 4-month-old infant was seen with hypokalemic metabolic alkalosis that was associated with prior application of liberal amounts of sodium bicarbonate (baking soda) to a diaper rash. After exclusion of other etiologies of the infant's acid-base disturbance, a complete resolution occurred following discontinuation of the baking soda applications. This case report provides a reminder of the significant side effects that may result from the excessive use of a seemingly harmless household substance.

Diaper dermatitis with psoriasiform ID eruption

Diaper dermatitis with psoriasiform ID eruption has a distinct clinical presentation. Its etiology and relationship to psoriasis remain uncertain. Previous reports have shown histologic features of subacute to chronic dermatitis. Two cases are presented in which a biopsy of secondary lesions showed features characteristic of psoriasis. It is possible that such cases represent those patients with a psoriatic diathesis.