Severe Extravasation Injuries in Neonates: A Report of 34 Cases.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Nikolaos
N
Kostogloudis
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Efterpi
E
Demiri
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Antonios
A
Tsimponis
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Dimitrios
D
Dionyssiou
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Sotirios
S
Ioannidis
2nd Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Ilias
I
Chatziioannidis
2nd Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
Nikolaos
N
Nikolaidis
D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D004487:Edema / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D017695:Soft Tissue Injuries / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology