Preventing the scars of neonatal intensive care.

Abstract

Two cases are reported of serious extravasation injuries due to parenteral nutrition in infants born at 24 and 28 weeks' gestation. Major scarring and the need for plastic surgery were prevented by using a technique of subcutaneous hyaluronidase and saline flushing.

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

“…Other pharmacotherapies for norepinephrine extravasation have remained largely ineffective or are underreported. Hyaluronidase, an enzyme that facilitates the degradation of the extracellular matrix, should be Total parenteral nutrition 42,48,53,54 Calcium chloride 10% (2040 mOsm/L) 48,55,56,59 Calcium gluconate (669 mOsm/L) 48,55,56,59 All agents: Direct cellular damage due to osmotic shifts from cellular membrane, cell volume dysregulation, DNA damage, apoptosis, and inflammation. Other agents: Aminophylline (10 mOsm/L) 48 Dextrose 10-50% (504-2520 mOsm/L) 49 Mannitol 20% (1369 mOsm/L) 43 Hypertonic saline (concentration dependent) Dry heat and elevation remain treatment of choice for pH-related extravasations…”

“…42 Hyaluronidase has also been successful in the management of neonatal TPN extravasations, in combination with aggressive saline flushing of the affected tissue. 53 Nitroglycerin has also been attempted for the treatment of extravasation in a neonate receiving TPN, although tissue sloughing still occurred despite treatment. 54 …”

Extravasation of Parenteral Nutrition in the Neck: A Case Report

“…A variation of this technique combining saline lavage with suction has been which was performed on a patient with doxorubicin extravasation injury [17]. The saline flush-out technique described by Gault was used in the neonatal intensive care setting to treat two newborns with TPN extravasation [6,8]. Both infants healed with minimal scarring and no functional defect [6].…”

“…The extravasation of total parenteral nutrition (TPN), largely an irritant, has most commonly been reported in newborns in the intensive care setting [6]. However, there are only a few case reports of this occurring in adults with the vast majority of reports over a decade old [3,[6][7][8][9][10] (Table 1).…”

“…However, there are only a few case reports of this occurring in adults with the vast majority of reports over a decade old [3,[6][7][8][9][10] (Table 1). TPN is a complex mixture of a wide variety of substances including amino acids, dextrose, lipids, vitamins, electrolytes and trace elements [4].…”