Early recognition of neonatal abdominal wall necrotizing fasciitis

• Published in: The American journal of surgery Vol. 167; no. 5; pp. 481 - 484
• Main Authors: Sawin, Robert S., Schaller, Robert T., Tapper, David, Morgan, Alan, Cahill, John
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1994; Elsevier; Elsevier Limited
• Subjects: Abdomen; Abdominal Muscles; Abdominal wall; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Blood; Debridement; Diagnosis; Discoloration; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Fasciitis; Fasciitis - diagnosis; Fasciitis - etiology; Fasciitis - therapy; Heart rate; Humans; Hyperbaric oxygen therapy; Hyperbaric Oxygenation; Infant, Newborn; Infants; Inflammation - complications; Intensive care medicine; Leukocytes; Medical sciences; Necrosis; Necrotizing fasciitis; Neonates; Omphalitis; Skin; Survival; Tachycardia; Umbilicus; Human; Skin disease; Intensive care; Early stage; Infection; Antibiotic; Chemotherapy; Newborn; Treatment; Surgery; Necrotizing fasciitis; Bacteriosis; Abdominal wall; Diagnosis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/0002-9610(94)90239-9

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires early diagnosis followed by aggressive surgical débridement. During a 10-year period, we treated 7 infants who developed NF. During the same period, 32 infants were admitted with omphalitis that did not progress to NF. The patients with omphalitis and those with NF were compared. Tachycardia, abnormal white blood cell counts, induration, and violaceous skin discoloration were seen exclusively in the NF patients. Polymicrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients. All omphalitis patients survived, whereas 5 of 7 (71%) NF patients died. Adjuvant hyperbaric oxygen therapy was used for 4 infants with NF, 2 of whom survived (50%). NF is a highly morbid disease, that can be distinguished from other infant abdominal wall infections by the skin changes, white blood cell counts, heart rate, and microbiologic results. Prompt diagnosis of NF improves survival when combined with aggressive surgical débridement.