No abstract

A markedly acid surface reaction is a characteristic attribute of the healthy human skin. The physiologic occurrence of strictly localized zones where acidity is diminished has been the subject of previous reports 1,2; they deal primarily with differences among the skin pH patterns of children, adolescents, and adults.Little is known about the skin pH of infants during the first month after birth. The only pertinent investigation known to us is that of Taddei.3 His findings uniformly demonstrate that the skin pH is maintained in the neighborhood of 6.5 from birth through the 20th day. The presence of such uniform and relatively elevated values would tend to indicate that the mechanism responsible for the physiologic acidification of the skin surface has not yet developed in these young infants.Our own studies do not confirm Taddei's findings. It is the purpose of this communication to report the results of skin pH determinations obtained from a series of infants from birth through the first month and to discuss the physiologic implications. Subjects Tested and Methods of ExaminationThe report is based on 945 individual pH de¬ terminations carried out in 222 subjects ranging in age from 1 hour to 30 days. Serial determina¬ tions were done on 27 infants; all other subjects were tested at one age only. The whole series includes 109 boys and 113 girls; of these, 64 were Caucasians; 60, Negroes, and 98, Puerto Ricans. They were selected from hospital nurseries, wards, and a few from private practice. They were healthy full-term babies of not less than 5 lb.(2470 gm.), afebrile and without noticeable dis¬ ease. Some of the older infants were convalescing from illness or surgery. The presence of skin eruptions excluded selection for testing. Skin pH determinations were carried out ac¬ cording to the colorimetrie method of Bernstein and Herrmann,4 with slight modifications as described and evaluated in earlier reports.1,2 A solu¬ tion * prepared according to the originally recom¬ mended formula served as indicator throughout. In addition to the requirements applying to colori¬ metrie skin testing in general, some special pre¬ cautions were felt to be in order prior to testing newborns. The use of soaps, detergents, or other chemicals was strictly avoided. Only plain water was used for routine cleansing of the skin after birth. Application of baby toiletries prior to and during the test period was prohibited.As in earlier investigations, the results were checked potentiometrically, at times, by means of the Beckmann pH meter, in conjunction with the special glass electrode devised for the examination of minute traces of aqueous material on small surface areas.6With a few exceptions, the skin pH was tested in each infant and at each session at three sites :(1) on the shoulder where the deltoid covers the acromion ; (2) on the armpit, in an area roughly corresponding to the axillary vault, and (3) on the abdomen at a site at least 2 in. lateral to and either just proximal to or just distal to the navel. Separate testing of ...

Management of 50 experimental newborn infants ill with narcotic withdrawal has been carried out with the aid of an instrument developed for measuring its severity, the Neonatal Narcotic Withdrawal Index (NNWI). With its use, infants exposed to methadone in utero have been successfully cared for with detoxification needed in less than 25% of cases and for durations of less than 2 weeks. The percentage of cases and the length of treatment is much less than is customary for infants who have been prenatally exposed to similar doses of methadone. Validity of the NNWI is shown by the statistically significant difference between the mean scores for experimental and control subjects, a high significant correlation between simultaneously measured scores by separate examiners, statistically significant correlations between subscores and total withdrawal scores for the narcotic-exposed experimental cases, and for this group, a statistically significant correlation between scores of withdrawal and the maternal dose of methadone. The simplicity of the NNWI should help to make it acceptable for use by physicians.