GENERAL PURPOSE To provide wound care information that considers the specific physiology of neonates. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population. 2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. OBJECTIVE To discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. DATA SOURCES Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. STUDY SELECTION Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. DATA EXTRACTION Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. DATA SYNTHESIS Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. CONCLUSION This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.
Myelomeningocele (MMC) is a type of open neural tube defect characterized by exposure of the spinal cord through a defect in the skin and posterior hindbrain herniation through the foramen magnum. Outcomes vary but common morbidities include paraplegia, hydrocephalus, neurogenic bladder, scoliosis, and tethered cord. Fetal surgery, although not a cure, has been shown to decrease the risk of associated morbidity. A study of a neonate born at 39 5/7 weeks gestation status-post in utero fetoscopic MMC repair at 24 weeks gestation was presented in this study along with a concise review of the literature. Fasciocutaneous advancement flaps were made in utero to facilitate a tension-free midline closure and were left to heal secondarily. The neonate underwent uncomplicated spontaneous vaginal delivery but was noted to have a right flank hernia through the relaxing incision in addition to delayed healing of the left relaxing incision. According to authors, iatrogenic flank hernia following fetoscopic MMC repair has not been previously reported in the literature. Both defects were repaired primarily in layers with undermining and retroperitoneal domain was reestablished with imbrication of the overlying muscle on the right side. The authors report their experience to contribute to the scarce literature describing postnatal complications arising from this novel procedure.
Iron deficiency is the most common etiology of anemia worldwide and is often managed with varying methods of iron supplementation. Although rare, oral iron supplementation can perpetuate iron deficiency anemia by causing gastric ulceration and upper gastrointestinal bleeding in high-risk populations. However, this complication has not been previously described with intravenous iron supplementation. We present a case of a 63-year-old male with severe iron deficiency anemia on biweekly intravenous iron infusions and weekly packed red blood cell transfusions who presented with melena over several months. Upper endoscopy demonstrated a clean-based gastric body ulcer and nonbleeding gastric varices. Histology of the gastric ulcer was suggestive of iron-induced gastric mucosal injury. This case demonstrates that frequent utilization of intravenous iron and packed red blood cell transfusions may predispose certain patients to the development of iron-induced gastritis and ulceration.
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