Most neonatal dermatological problems are soft tissue infections and vesiculobullous illnesses. These disorders range from mild, self-limiting ailments to serious infections and hereditary diseases that can cause significant morbidity and mortality. Due to the fragility of neonatal and baby skin, quick identification and treatment are necessary to avoid problems and improve clinical results [1, 2].

Cellulitis, abscesses, infected cysts, necrotising infections, and subcutaneous inflammatory lesions are frequent neonatal soft tissue infections. These diseases are commonly caused by Staphylococcus aureus and Streptococcus pyogenes. Erythema, swelling, pain, warmth, and fluctuating masses may occur. Physical examination alone may not always distinguish cellulitis from abscess formation, delaying therapy or requiring unneeded invasive procedures. Diffuse soft tissue inflammation and localised abscesses require different therapy modalities, thus early fluid collection detection is crucial [3-5].

Vesiculobullous diseases are another major neonatal skin problem. These illnesses cause skin and mucous membrane vesicles, bullae, pustules, or erosions. Bullous impetigo, neonatal herpes simplex infection, transient neonatal dermatoses like erythema toxicum neonatorum and pustular melanosis, and hereditary illnesses like epidermolysis bullosa are common causes. Physical examination may not be enough to diagnose many illnesses because they may look similar [6, 7].

Imaging is being used to diagnose paediatric skin and soft tissue problems. Ultrasonography (USG) is a helpful diagnostic tool due to its non-invasiveness, lack of ionising radiation, portability, cost-effectiveness, and real-time examination of superficial tissues. High-frequency ultrasound transducers reveal skin, subcutaneous tissue, fascial planes, and fluid collections. Colour Doppler imaging also detects vascularity and inflammation, aiding diagnosis [8].

Ultrasonography can distinguish cellulitis from abscesses, assess infection severity, detect occult fluid collections, and assist drainage in soft tissue infections. Ultrasound can also assess lesion form, skin involvement, fluid volume, and inflammatory changes in vesiculobullous illnesses. Neonatal and baby diagnostics should minimise invasive procedures, therefore these capabilities are very useful [9].

Advanced high-resolution ultrasonography is being used in paediatric dermatology and soft tissue imaging. Ultrasonography improves diagnostic confidence, reduces unnecessary surgery, and aids early treatment planning, according to several studies. However, research on its use in neonatal and infant soft tissue infection and vesiculobullous disease examination is scarce [10]. Since neonates and infants are vulnerable to dermatological conditions, this study examined the diagnostic accuracy and clinical utility of ultrasonography in assessing soft tissue infections and vesiculobullous disorders.

Study Design and Study Population: A prospective observational study was conducted to evaluate the role of ultrasonography in the assessment of soft tissue infections and vesiculobullous disorders in neonates and infants. This study was conducted at Department of Radio-Diagnosis, Kanya Kumari Medical Missions Medical College, Muttom, Tamil Nadu, India between July 2024 to June 2025. The study included 40 newborns and infants aged birth to 12 months with clinically suspected soft tissue infections or vesiculobullous skin diseases. Before starting the study, the Institutional Ethics Committee approved it and all participants' parents or legal guardians gave written informed consent. Methods: The clinical evaluation of all recruited patients included history taking, physical examination, and lesion characteristics such as location, size, duration, erythema, swelling, discomfort, vesicle development, bullae, pustules, and systemic symptoms. Ultrasonography was performed utilising a high-resolution ultrasound equipment with a 7–15 MHz linear-array transducer. Under standard conditions, experienced radiologists performed scans. Sonographic results classified lesions as cellulitis, abscess, infected cyst, inflammatory soft tissue lesion, bullous disorder, or other dermatological problems. Ultrasonographic diagnoses were connected with clinical observations, laboratory tests, microbiological culture reports (if available), treatment response, and final clinical diagnosis. Ultrasonography effectiveness was measured by sensitivity, specificity, PPV, NPV, and diagnostic accuracy. Inclusion Criteria: 1. Neonates and infants aged 0–12 months. 2. Patients presenting with clinically suspected soft tissue infections such as cellulitis, abscesses, infected cysts 3. Patients presenting with vesiculobullous skin disorders including bullous impetigo, epidermolysis bullosa, neonatal herpes infection, transient neonatal pustular melanosis, and related conditions. 4. Patients whose parents or guardians provided written informed consent. 5. Patients who underwent complete ultrasonographic evaluation. Exclusion Criteria: 1. Infants older than 12 months of age. 2. Patients with previously diagnosed chronic dermatological disorders unrelated to the study objectives. 3. Patients who had undergone surgical intervention before ultrasonographic examination. 4. Patients with incomplete clinical or imaging records. 5. Patients whose parents or guardians declined participation. 6. Critically ill patients in whom ultrasonographic examination could not be safely performed. Statistical Analysis: Excel and SPSS 26.0 were used to analyse data. Data was reported as mean ± standard deviation (SD) for continuous variables and frequencies and percentages for categorical variables. Ultrasonography's diagnostic performance was measured by sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy using the final clinical diagnosis as the reference standard. Where applicable, the Chi-square or Fisher's exact test was used to analyse categorical variable associations. A p-value under 0.05 was significant. Interobserver ultrasonographic agreement was assessed using Cohen's kappa coefficient. Tables and graphs were used to explain ultrasonography's diagnostic relevance in newborns and babies with soft tissue infections and vesiculobullous diseases.

A total of 40 neonates and infants with clinically suspected soft tissue infections or vesiculobullous disorders were included in the study. All patients successfully underwent ultrasonographic examination and subsequent clinical correlation. Ultrasonography demonstrated high diagnostic utility in differentiating inflammatory lesions, abscesses, and vesiculobullous conditions.

Table 1: Demographic Characteristics of the Study Population

Table 1 summarizes the demographic characteristics of the study participants. Of the 40 patients evaluated, 18 (45.0%) were neonates and 22 (55.0%) were infants. Male patients constituted 60.0% of the study population, while females accounted for 40.0%. The mean age was 4.8 ± 3.7 months.

Table 2: Distribution of Diagnosed Conditions Among Study Participants

Table 2 presents the distribution of final diagnoses. Soft tissue infections accounted for 24 cases (60.0%), while vesiculobullous disorders comprised 16 cases (40.0%). Abscesses were the most common diagnosis (25.0%), followed by cellulitis (22.5%) and bullous impetigo (17.5%).

Table 3: Ultrasonographic Findings in Soft Tissue Infections

Table 3 demonstrates the major ultrasonographic findings observed in patients with soft tissue infections. Skin thickening was the most frequent finding (83.3%), followed by subcutaneous edema (75.0%) and increased Doppler vascularity (70.8%). Fluid collections were identified in 50.0% of cases, facilitating differentiation between cellulitis and abscess formation.

Table 4. Ultrasonographic Characteristics of Vesiculobullous Disorders

Table 4 summarizes ultrasonographic findings in vesiculobullous disorders. Superficial fluid-filled lesions were observed in the majority of patients (87.5%). Epidermal separation was particularly evident in cases of epidermolysis bullosa, while increased peripheral vascularity was commonly associated with inflammatory and infectious bullous lesions.

Table 5: Diagnostic Performance of Ultrasonography

Table 5 shows the diagnostic performance of ultrasonography compared with the final clinical diagnosis. Ultrasonography demonstrated a sensitivity of 92.5% and specificity of 88.9%. The overall diagnostic accuracy was 90.0%, with a Cohen's kappa coefficient of 0.82 indicating excellent agreement between ultrasonographic findings and final diagnosis.

Table 6: Impact of Ultrasonography on Clinical Management

Table 6 illustrates the influence of ultrasonography on patient management. Ultrasonography confirmed the initial clinical diagnosis in 70.0% of cases and altered the preliminary diagnosis in 15.0% of patients. The modality also aided in guiding abscess drainage procedures and prevented unnecessary surgical interventions in selected cases.

In newborns and infants, soft tissue infections and vesiculobullous illnesses induce dermatological morbidity. Delays in diagnosis might cause illness progression, systemic consequences, prolonged hospitalisation, and higher healthcare expenses. Clinical examination is the foundation of diagnosis, yet many skin and soft tissue disorders overlap, making separation difficult [11]. This study showed that ultrasonography is a good diagnostic technique with high sensitivity, specificity, and accuracy for various illnesses [12]. In this study, 60.0% of patients were soft tissue infections and 40.0% were vesiculobullous illnesses. Abscesses and cellulitis were the most common soft tissue infections. These findings support earlier paediatric studies that found bacterial skin and soft tissue infections account for a large share of childhood dermatological appointments. Due to their underdeveloped immune systems, susceptibility to bacterial colonisation, and vulnerability to minor trauma and infection, newborns and babies have a greater rate of abscesses and cellulitis [13-15]. Ultrasound was also useful in diagnosing vesiculobullous diseases. The majority of patients had superficial fluid-filled lesions and variable epidermal detachment. This was especially true for epidermolysis bullosa and bullous impetigo sufferers. Infectious bullous diseases and hereditary or transitory newborn illnesses have different therapy techniques and prognoses, making differentiation crucial. Lesion morphology and depth were visualised using ultrasonography without ionising radiation or invasive treatments [16]. Ultrasonography's 92.5% sensitivity, 88.9% specificity, and 90.0% diagnostic accuracy were key findings of this investigation. The final clinical diagnosis matches sonographic data well. Ultrasonography has a low false-positive rate and good sensitivity for detecting real illness cases. Ultrasonography is reliable in clinical practice due to good concordance and a Cohen's kappa coefficient of 0.82 [17]. Also significant was ultrasonography's impact on patient treatment. Ultrasonography validated the clinical diagnosis in 70.0% of cases and changed it in 15.0%. Additionally, ultrasound-guided decision-making helped drain abscesses and avert unnecessary surgery in some situations. These data show that ultrasonography is useful not just for diagnosis but also for therapy planning and patient outcomes [18, 19]. Tertiary care centers may have introduced referral bias to the study. Many instances were diagnosed based on clinical correlation and therapeutic response, not microbiological or histological confirmation. Ultrasonography's usefulness in paediatric dermatological problems should be confirmed by multicenter studies with bigger populations and standardised diagnostic criteria [20, 21]. This study shows that ultrasonography is safe, effective, and reliable for evaluating neonatal soft tissue infections and vesiculobullous diseases. It is used as a first-line imaging tool in paediatric dermatology and soft tissue imaging because it can properly characterise lesions, distinguish pathological states, and guide therapeutic care [22, 23].

Ultrasonography is a useful and reliable imaging method for neonatal and infant soft tissue infections and vesiculobullous diseases, according to this study. High-resolution ultrasonography accurately distinguished cellulitis, abscesses, infected cysts, and vesiculobullous diseases across skin and subcutaneous tissue anomalies. The modality outperformed clinical diagnoses in sensitivity, specificity, and accuracy. Ultrasonography helped locate fluid collections, estimate lesion extent, analyse inflammatory changes, and identify conditions that require various treatments. Its non-invasiveness, mobility, lack of ionising radiation, and real-time imaging make it ideal for neonates and infants. Ultrasonographic data confirmed diagnosis, guided treatment, and reduced unneeded invasive procedures, aiding clinical decision-making. These findings suggest that ultrasonography should be the first imaging method for paediatric soft tissue infections and vesiculobullous diseases. Its widespread use in clinical practice may improve neonatal and infant care by facilitating early diagnosis, optimising patient treatment, and improving clinical outcomes. Large-scale multicenter investigations are needed to confirm these findings and standardise paediatric dermatological and soft tissue ultrasonographic techniques.

Funding:

Not applicable.

Conflict of interest:

The authors declare that they have no conflict of interest.

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