Kostogloudis Nikolaos, Demiri Efterpi, Tsimponis Antonios, Dionyssiou Dimitrios, Ioannidis Sotirios, Chatziioannidis Ilias, Nikolaidis Nikolaos
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
2nd Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Pediatr Dermatol. 2015 Nov-Dec;32(6):830-5. doi: 10.1111/pde.12664. Epub 2015 Sep 4.
Extravasation injuries are a common and challenging problem in hospitalized newborns. Accidental infusion leakage into the surrounding tissues in immature infants may frequently result in skin necrosis, with significant risk of functional and cosmetic impairment.
In the present study we reviewed 34 cases of severe extravasation injuries occurring in 1,409 neonates hospitalized in a single neonatal unit over 24 months (incidence 2.4%). Total parenteral nutrition solutions were involved in most cases. All patients were treated within 30 minutes after the injury was recorded using a flush-out technique with normal saline irrigation and occlusive paraffin dressings of the infiltrated area.
The majority of injuries affected preterm, low-birthweight infants (mean gestation 32 wks + 6 days, mean birth weight 1,885 g), with a mean age at the time of injury of 11.6 days and a mean weight of 2,045 g. Neither gestational age (p = 0.87) or birthweight significantly affected (p = 0.07) the incidence of extravasation injuries, although the incidence of skin necrosis had a significant correlation with gestational age (p = 0.009) and birthweight (p < 0.001). All patients responded well to treatment and their wounds healed uneventfully within a maximum of 25 days without the need for secondary surgery for skin coverage.
Extravasation injuries in extremely preterm and low-birthweight infants are more likely to lead to skin necrosis. Peripheral venous catheterization should be performed with caution in these patients to prevent such injuries. Immediate irrigation with normal saline is recommended to reduce toxic sequelae in the infiltrated area.
外渗性损伤是住院新生儿中常见且具有挑战性的问题。未成熟婴儿意外输注液体渗漏到周围组织中常常会导致皮肤坏死，存在功能和外观受损的重大风险。
在本研究中，我们回顾了在一个新生儿病房24个月内住院的1409例新生儿中发生的34例严重外渗性损伤（发生率2.4%）。大多数病例涉及全胃肠外营养溶液。所有患者在记录到损伤后的30分钟内接受治疗，采用用生理盐水冲洗并对浸润区域使用封闭性石蜡敷料的冲洗技术。
大多数损伤影响早产、低体重婴儿（平均孕周32周+6天，平均出生体重1885克），损伤时的平均年龄为11.6天，平均体重为2045克。孕周（p = 0.87）或出生体重均未显著影响（p = 0.07）外渗性损伤的发生率，尽管皮肤坏死的发生率与孕周（p = 0.009）和出生体重（p < 0.001）有显著相关性。所有患者对治疗反应良好，其伤口在最长25天内顺利愈合，无需进行二期皮肤覆盖手术。
极早产和低体重婴儿的外渗性损伤更有可能导致皮肤坏死。在这些患者中进行外周静脉置管时应谨慎，以防止此类损伤。建议立即用生理盐水冲洗，以减少浸润区域的毒性后遗症。
