What Are the Signs of Infection in Aplasia Cutis Congenita?

When caring for a newborn with aplasia cutis congenita (ACC) at home, distinguishing between normal wound healing and an infection is critical. With proper monitoring and care, most ACC wounds heal beautifully over time ^[1]. Healthy healing typically features pink or red, shiny tissue that slowly shrinks as the body repairs the defect ^[2]. In contrast, an infection will cause noticeable changes in the wound itself—such as thick yellow or green pus, a foul odor, and spreading redness—along with potential changes in your baby’s overall behavior, such as a fever or lethargy ^[3][4].

What Healthy Healing Looks Like

As your baby’s skin defect begins to repair itself, it forms granulation tissue, which is the new connective tissue and tiny blood vessels that develop on the surface of an open wound. You can identify normal, healthy healing by looking for:

• Color: The tissue should be a healthy pink or “beefy” red ^[1].
• Texture and appearance: It often looks moist, slightly bumpy, and shiny ^[2].
• Progression: The wound should gradually shrink over time.
• Scabbing: In some cases, a dark scab—called an eschar—may form and cover the ulceration before it heals entirely ^[2].

Important: Never pick, peel, or scratch the eschar. Let it fall off naturally to avoid disrupting the fragile healing tissue underneath or triggering unnecessary bleeding.

Warning Signs of Infection

If bacteria enter the open wound, an infection can develop rapidly. Because infants have immature immune systems, it is vital to monitor for these local and systemic warning signs ^[3][4]:

• Changes in discharge: Look for thick, cloudy pus that appears yellow or green.
• Odor: A foul or bad smell coming from the wound area.
• Spreading redness: Redness that expands beyond the immediate edges of the wound into the surrounding healthy skin.
• Warmth: The skin surrounding the defect feels unusually hot. You can check this safely by lightly hovering the back of your hand over the area without pressing down on the fragile defect.
• Systemic illness: The baby begins acting extremely sleepy (lethargic), refuses to feed, or develops a fever of 100.4°F (38.0°C) or higher. For newborns, a rectal thermometer provides the most accurate reading, and any fever is a medical emergency.

Why Immediate Action is Necessary

If you suspect an infection, contact your pediatrician or seek immediate medical care. While severe complications are rare, prompt action is critical because ACC lesions on the scalp can sometimes overlie areas where the underlying skull bone has not fully formed. Your doctor will typically evaluate your baby for this using early imaging, like an ultrasound ^[5].

Because of this potentially missing bone barrier, an untreated surface skin infection can spread inward and cause life-threatening complications, including acute bacterial meningitis (an infection of the protective membranes surrounding the brain and spinal cord) ^[3][4]. Additionally, if the wound is located over the superior sagittal sinus (a large vein running front-to-back under the top of the skull), inflammation or trauma to the area carries a risk of severe hemorrhage (bleeding) ^[3][6].

Your care team will tell you if your baby’s wound is in a high-risk area. Being vigilant without panicking is key—never hesitate to contact your doctor if a wound appears infected or if your baby’s behavior changes.