Neonatal Impetigo - Causes, Risk Factors, Symptoms, and Treatment

What Is Neonatal Impetigo?

Impetigo is a common bacterial skin infection that affects both infants and children. Bacteria (Staphylococcus or Streptococcus) enter a cut or break in the skin to cause impetigo. Blisters first appear on the baby's skin near the nose and mouth before spreading to other parts of the body. Depending on the kind of impetigo that the baby has, the blisters may be of different sizes. While larger blisters burst after a few days, smaller blisters burst rather early to form sores. Because it is extremely contagious and spreads fast among children, impetigo is known as school sores. After the blisters burst, the skin is left with sores in the shape of coins. These are covered by a brownish-yellow scab that takes some time to heal but rarely leaves a scar.

Although impetigo is typically a mild infection that can be treated easily, it may progress to more severe symptoms such as meningitis, kidney inflammation, or deep skin infections (cellulitis). Impetigo can be further classified into two types: bullous and non-bullous.

• 70 percent of cases of impetigo are non-bullous types and occur as tiny, fluid-filled blisters that progress into honey-colored, crusty lesions. In most cases, they do not sting or cause any redness or irritation on the skin around them.

• In infants, bullous impetigo is more common and appears as clear blisters filled with fluid that are larger in size. Once ruptured, these blisters may leave a scale behind.

What Causes Neonatal Impetigo?

Staphylococcus or Streptococcus strains of bacteria cause neonatal impetigo. Both of these are commonly found bacterial species that are known to spread quickly in warm climates. They are often found on the skin, nose, or throat of the baby without causing any problems. A bacterial infection of healthy skin is uncommon. However, the bacteria may reactivate and cause the impetigo infection if the skin has a scratch, cut, bite, or disease, such as eczema or chicken pox. After being exposed to the bacteria, the infection takes four to ten days to develop.

What Are the Risk Factors?

Impetigo can affect people of any age, but infants and children in school are more likely to experience it. Parents should look for a sore with a honey-colored crust. Infants are more likely to develop bullous impetigo, which typically manifests on the face, buttocks, and diaper area. Due to the insufficient development of their immune systems, infants are more susceptible to these infections. Poor skin cleansing and insect bites, which can be scratched, are two additional risk factors. Additionally, touching a contaminated object (fomite) can spread impetigo. It quickly spreads through daycares and nurseries.

What Are the Symptoms of Neonatal Impetigo?

The symptoms of both non-bullous and bullous impetigo have been described below.

Symptoms of Non-bullous Impetigo:

• Blisters typically begin near the mouth or nose before spreading to the limbs and other parts of the body.

• A sore is a red, wet patch of skin that forms when blisters burst.

• Before forming a supple, yellowish-brown crust, the skin of the sore oozes fluid for some time.

• In about three days, the crust forms a scab and gets healed. During healing, the scab may peel a little at the edges.

• As long as the baby is not allowed to scratch the sore while it is healing, there will be no scar.

Symptoms of Bullous Impetigo:

• Compared to non-bullous impetigo infections, the bullae, or fluid-filled blisters, are almost two centimeters in diameter in the bullous type.

• The blisters first appear on the baby's torso, typically between the neck and waist, and then eventually spread to the limbs and the rest of the body.

• The blisters may be painful and uncomfortable and take longer than usual to burst. In addition, the baby must not scratch the blisters because the skin around them usually tends to be itchy.

• In bullous impetigo, fever and swollen lymph nodes in the neck are more common. The scabs also take longer to heal.

Impetigo-associated infections may be of the following types:

• Mild- The child feels fine otherwise, and there are only a few of either type of lesion on a small skin area.

• Moderate- There are more than ten lesions and several small areas of skin affected.

• Severe- The lesions may be numerous, and a lot of the skin is affected. The child may also experience symptoms such as weakness, fever, or diarrhea.

How to Treat Neonatal Impetigo?

For mild infections, the following measures must be taken:

• Cover the area with gauze or a non-stick dressing if at all possible, and gently wash it twice daily with water and mild soap.

• After washing the skin three to four times per day, apply an antibiotic ointment purchased over the counter. After application, hands must be washed, or gloves must be used to apply the ointment.

• Soak for 15 to 20 minutes in a vinegar solution (one pint of water to one tablespoon of white vinegar) to remove crusts.

• The clothes, towels, and bedding must be washed every day, and sharing of personal belongings must be avoided with anyone else.

• Fingernails must always be kept clipped, hands washed frequently, and the affected areas must not be touched.

• The child must be kept at home until any open wounds or scabs heal.

In addition to the measures mentioned earlier for mild impetigo, the doctor may also prescribe:

• Antibiotics are to be applied topically, usually Mupirocin.

• Orally taken antibiotics such as Amoxicillin, Cephalosporins, Dicloxacillin, Cloxacillin, Erythromycin, or Clindamycin.

Without medication, mild cases may resolve in two to three weeks. However, it is preferable to medicate the infant because, with the right ointments, the illness lasts only seven to ten days and significantly lessens their suffering. Importantly, if the infection is not treated, it may cause complications like cellulitis, a more severe skin condition. Rarely, in some cases, it could develop into psoriasis (skin rash with itchy, scaly patches), septicemia (fatal bacterial blood infection), scarlet fever (bacterial illness with a sore throat, high fever, and a bright red rash all over the body), and even a kidney disorder known as glomerulonephritis (damage to the tiny kidney filters). But, again, these complications are very rare.

Conclusion

Neonatal impetigo is a bacterial skin infection that is a common occurrence in babies and school-going kids. It is usually manifested in two forms, bullous or non-bullous. Depending on the type, the symptoms may vary. At-home measures are usually sufficient for mild infections and help treat them easily. If the infection is more severe, a visit to the doctor is recommended.