Scalp Hair Characteristics in the Newborn Infant

Susan A. Furdon, RNC, MS, NNP; David A. Clark, MD


Adv Neonatal Care. 2003;3(6) 

In This Article

Implications for Clinical Practice

Hair characteristics are inherited and both typical and atypical findings may be familial in nature. The clinician must be sensitive to the wide variation of normal scalp hair. In the delivery room, hair color provides the family's first glimpse into their infant's genetic makeup. Families often ask questions about the inheritance of hair color and characteristics. Understanding the phases of hair growth, type of hair present in the newborn period, the process of melanin production, and normal changes in hair color can assist the clinician in providing explanations to the family.

Before attaching significance to any unusual hair feature, it should be evaluated within the context of the infant's race and family characteristics.[3] Initially, this can be accomplished by discussing the newborn's hair characteristics with the mother and comparing and contrasting the findings. Perform a more in-depth family history, focusing on hair and skin disorders. This may reveal additional relevant information.

Abnormal hair characteristics are usually not isolated; they often occur as a constellation of findings. Systematically assess the infant, from head to toe, with special attention to additional abnormalities of the skin, hair, nails, or other embryologically related structures that arise from the neuroectoderm.

Document abnormalities, noting the color, texture, configuration, and hairlines. Characterize abnormalities as focal or localized, isolated, or diffuse. Carefully describe any other atypical associated features. Changes in hair patterns over time may be diagnostic: detailed clinical photographs, obtained at the time of presentation, may aid the recognition of an emerging of evolving condition.

Explore known associations between physical findings using internet resources such as Online Mendelian Inheritance in Man (OMIM) or Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) syndromes database (see Sidebar). Depending on the level of suspicion, a genetics consult may be appropriate to further evaluate the infant and family for dysmorphology, obtain a family pedigree, and recommend additional diagnostic testing. Pediatric neurology, dermatology, and metabolic consultations may also provide useful perspectives and important diagnostic and prognostic information.

Some of the metabolic disorders that result in abnormal hair characteristics (alopecia, abnormal hair texture, and hypopigmentation) are screened systematically by many state newborn screening panels. These include PKU, congenital hypothyroidism, homocystinuria, and biotinidase deficiency. Every state, the District of Columbia, and all Canadian provinces screen for PKU and congenital hypothyroidism; however, state screening panels for other disorders vary significantly.[19] Be aware of the tests included in your state's newborn screening panel and the process by which results are reported to the infant's medical care providers. Follow up on outstanding test results. Consider additional testing if conditions related to abnormal hair characteristics are not included in the standard state screening panel.

Infants nourished primarily with long-term hyperalimentation are at risk for acquired metabolic or nutritional deficiencies, such as zinc, that can affect hair growth and quality. A pediatric nutritionist or pediatric gastroenterologist can be instrumental in diagnosing and providing treatment for nutritional deficiencies.

There has been preliminary use of hair analysis as a screening tool to diagnose genetic diseases on the basis of spectral differences. Infrared microspectroscopy can detect G6PD deficiency and may be used as an adjunct diagnostic tool to serum and urine analysis.[18] The following diagnostic studies may be useful to complete evaluation of an infant with abnormal hair[20]:

  • Magnetic resonance imaging (MRI)

  • Chromosome analysis or probes for single gene disorders

  • Fluoresence in-situ hybridization (FISH) analysis

  • Light microscopy evaluation of the hair shaft

  • Hair or skin biopsy

  • Neogen screen or further specific testing for suspected metabolic disorders

Advanced knowledge of newborn hair and its potential significance can greatly enhance the neonatal caregiver's assessment skills. A comprehensive, standardized assessment of the newborn's hair is an important tool in the early recognition of genetic, metabolic, or neurologic disorders.


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