OEDEMA NEONATORUM

Synonyms.—Edema of the newborn; Ger., Das Sklerödem.

Symptoms.—The characteristic symptoms of this affection are
edema and variable hardness or induration, in both these respects cor­
responding somewhat to the edematous type of scleroderma in the adult.
It begins almost invariably on the legs, very exceptionally on other parts,
such as the face or trunk, and, as a rule, in the first day or two of life.
It is sometimes preceded by drowsiness, or this develops with the cuta­
neous phenomena. Beginning usually on the lower part of the legs, it
gradually creeps upward, and about the same time the hands are likely
to show involvement, and then other parts. It .is rarely general. Ex­
ceptionally it is limited to the lower porton of both extremities, especially
the hands and feet (J. L. Smith). To the touch the parts are either some­
what rigid, due to enormous serous infiltration, or they are soft and
doughy, and pit upon moderate pressure. The skin is of a yellowish,
dusky, or livid color, and sometimes glossy or shining. The general
symptoms of drowsiness, feeble circulation, and weakened respiratory
action usually increase; the temperature is noted to be below the normal,
and sooner or later, with some exceptions, from some intercurrent affec­
tion or complication superinduced by the patient‘s condition, such as
diarrhea, pulmonary disease, nephritis, with collapse, lead rapidly to the
end.

Its chief differences from sclerema neonatorum are the edematous
infiltration, always most marked in dependent regions, the absence of
pronounced integumentary sclerosis and articular immobility, the pitting
upon pressure, and less general rigidity, and its less generalized distribu­
tion.

¹ Ballantyne, Brit. Med. Jour., Feb. 22, 1890, p. 403, and editorial comment, p.

439-

² Wiederhofer, in Gerhardt‘s Handbuch der Kinderkrankheiten, 1880, vol. iv, 2.
Abth., p. 557.

³ Soltmann, Eulenberg‘s Real-Encyclopädie, 1899, vol. xxii, p. 482 (excellent con­
tribution both as to sclerema neonatorum and œdema neonatorum, with full bibliog­
raphy).

592

HYPERTROPHIES

Etiology.—It develops in the first few days of life. The causes
seem to vary in different cases, although, as a rule, feeble, ill-nourished,
premature infants, with marked cardiac weakness, are its usual subjects,
and especially in the children of ill-fed and insufficiently nourished
mothers. Pulmonary atelectasis, nephritis (Elsässer, Henoch),¹ heredi­
tary syphilis (Soltmann²), erysipelas (J. L. Smith), incomplete establish­
ment of respiration (Dumas), exposure to cold immediately after birth
(Crocker³), have been variously considered as influential in some cases.
On the other hand, in Blacker‘s⁴ case there seemed an entire absence of
recognizable factors.

Pathology.—Ballantyne⁵ ascribes cedema neonatorum to dis­
turbances of the cardiac, pulmonary, renal, or vascular system, believing
it akin to anasarca in the adult. Dumas, from his studies and observa­
tions, considers the disease as a symptom of phlegmasia alba dolens,
which is developed during the first days after birth, but that the venous
thrombosis is more frequently located in the inferior vena cava than it is
in the adult. Jarisch⁶ believes the various observations made and the
autopsy findings, so often diverse, point rather to the condition being a
symptom or a part of other grave diseases, rather than an independent
malady. At all events, it consists essentially of an edema—a serous
transudation into the subcutaneous tissue. The fat is found to be some­
what dense, crumbly, or granular, and not infrequently of a yellowish
or brownish color. Autopsies have disclosed in some instances pulmo­
nary disease, venous thrombosis, nephritis, enlarged liver, etc.

Prognosis and Treatment.—According to Soltmann, at least
80 to 90 per cent, of the cases die. Treatment is essentially the same
as in sclerema neonatorum—increasing and maintaining the body-heat,
sufficient and proper nourishment, and stimulants. Dumas advises,
as a preventive measure, suitable care to establish thoroughly the respi­
ratory function in the newborn at the moment of birth, and not too
hasty ligation of the cord.

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