Medicine (Baltimore). 2025 Nov 14;104(46):e45850. doi: 10.1097/MD.0000000000045850.
ABSTRACT
RATIONALE: Critically ill neonates in the neonatal intensive care unit are at high risk of severe tissue damage from drug or total parenteral nutrition (TPN) extravasation due to their unique physiology, and traditional single-discipline management is often insufficient. This report presents a severe TPN extravasation case that was successfully treated through interdisciplinary collaboration.
PATIENT CONCERNS: A small-for-gestational-age infant was admitted to an external department for intractable vomiting and received TPN infusion. On the fourth day of treatment, severe fluid extravasation occurred at the puncture site on the left ankle, presenting with swelling, skin whitening, and evident tenderness. The skin broke down 6 hours later, forming a significant ulcer.
DIAGNOSES: The injury at the left ankle puncture site was diagnosed as a severe TPN extravasation, resulting in a grade IV skin injury with a 2.5 cm × 1.6 cm ulceration reaching the subcutaneous tissue.
INTERVENTIONS: After transfer from an external hospital where initial saline irrigation proved ineffective, our hospital initiated a multidisciplinary team (including plastic surgeons, orthopedic surgeons, wound/ostomy nurses, and neonatal staff). The team performed 6 staged debridements to remove necrotic tissue. Wound care involved sequential application of alginate, foam, hydrophilic fiber silver-containing, and hydrocolloid dressings, supplemented with recombinant human epidermal growth factor. Multimodal analgesia included lidocaine gel, fentanyl infusion, non-nutritive sucking, and oral glucose water.
OUTCOMES: After 27 days of treatment, the skin wounds dried and healed completely without exudation, and the patient was discharged. A follow-up 7 days after discharge confirmed complete skin healing without scarring and no limitations on physical activity.
LESSONS: For small-for-gestational-age infants receiving hypertonic/irritant medications like TPN, central venous access should be prioritized. It is crucial to formulate specific emergency protocols for neonatal TPN extravasation and incorporate them into nurse training. For cases of severe necrosis, interdisciplinary consultation is essential for optimal outcomes, with particular attention paid to comprehensive pain management and patient comfort.
PMID:41239625 | DOI:10.1097/MD.0000000000045850
