General characteristics and causes
Hormonal, or sexual, crisis is a regular reaction of the infant's organism to changes in the endocrine background. The condition is extremely common and occurs in approximately two-thirds of all newborns.
The main cause (etiological factor) is withdrawal syndrome. During intrauterine development, maternal estrogens enter the fetus's circulating blood. After birth, this connection is abruptly interrupted, the concentration of female sex hormones in the child's blood drops rapidly, which triggers a cascade of characteristic clinical manifestations. There are three main symptoms of this crisis, each of which has its own timing of manifestation and clinical course.
Physiological mastopathy
The most noticeable manifestation of the hormonal decline is physiological mastopathy, which is bilateral engorgement of the mammary glands.
Dynamics of the process development:
- Onset: the first visual and palpation signs of engorgement are noted on the 3rd–4th day of the infant's life.
- Peak of manifestations: the maximum severity of edema and enlargement of the glands occurs on the 8th–10th day.
- Resolution: the process is completely reversible, and the size of the glands returns to physiological norm spontaneously by the end of the 2nd or the beginning of the 3rd week.
Management tactics: This condition is transient; therefore, specific, pathogenetic, etiotropic, or surgical treatment is not required. To help with severe gland engorgement, pediatricians permit applying a dry warm compress.
Special instructions: The physician must warn parents that massaging the mammary glands or attempting to express secretion from them is strictly forbidden. Such actions are associated with an extremely high risk of infecting the glandular tissue.
Genital tract manifestations in girls
In newborn girls, the maternal hormone withdrawal syndrome is often accompanied by changes in the reproductive system. Clinically, this manifests as two conditions:
- Desquamative vulvovaginitis
This is the most common local manifestation, occurring in 60–70% of girls in the first three days after birth. Pathogenesis: under the influence of residual maternal hormones, rejection (desquamation) of epithelial cells and the glandular tissue of the cervix occurs. Clinical picture: visualized as abundant, sticky, grayish-white mucous discharge from the genital fissure.
- Genital tract bleeding
This symptom is much less common—occurring in only 5–7% of newborn girls. Dynamics: bloody discharge appears slightly later than vulvovaginitis, usually on the 4th–7th day of life, and lasts for a very short time (typically 1–2 days). Nature: the blood loss volume is strictly minimal, amounting to no more than 1–2 ml, which does not pose a threat to the child's hemodynamics.
General management principles: As with mastopathy, vaginal and uterine manifestations do not require prescription drug treatment. The main and only recommendation is ensuring regular hygiene and standard toilet care for the infant's external genitalia.
Three rules of the sexual crisis: Estrogens drop (cause), Glands engorge (mastopathy), Do not touch (ban on massage and expression).
Class and exam questions
What is the pathogenesis of the neonatal hormonal crisis?
It is based on withdrawal syndrome: after birth, there is a sharp decrease in the concentration of maternal estrogens in the child's systemic circulation.
How long does physiological mastopathy persist?
Mammary gland engorgement reaches its maximum on the 8th–10th day of life and disappears spontaneously by the end of the second to the beginning of the third week.
Do bloody discharges in newborn girls require treatment?
No, specific treatment is not indicated. Bleeding is minimal (1–2 ml), lasts 1–2 days, and requires only standard care of the external genitalia.
What is strictly prohibited when an infant's mammary glands are engorged?
It is strictly forbidden to express secretion and massage the glands, as this creates a high risk of tissue infection.
What else to study on this topic
- Features of differential diagnosis between physiological mastopathy and purulent neonatal mastitis
- Technique for applying a dry warm compress in pronounced mammary gland engorgement
- Algorithm for performing standard external genital care in girls with desquamative vulvovaginitis
- Cytological picture of the secretion during cervical epithelial rejection in newborns
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