Newborn Burned with Boiling Water

SavageGlow · #1 ● 05-03-2024, 07:07 PM

An eight-hour-old newborn male, with full-term normal caesarean delivery, weighing 3250 g was brought to the emergency room by his father. They admitted that, five hours ago, boiled water (about 90 °C, 194 °F) was accidently spilled over the baby for about 1 min. Cooling method and wound dressing were done immediately in the local hospital. Reviews of maternal, obstetric, and neonatal histories were not significant.

>>On examination, we found the neonate was awake, alert, and excessively crying. Vital signs were shown in Table 1. The patient’s face, chest, and left hand were badly injured, as shown in Fig. 1. Injured areas were pale and cold, with moderate exudate. Arterial Blood Gas Analysis and some other laboratory data were shown in Table 1. The diagnosis of admission was 1. Major full-thickness scald burn injury, 14%TBSA; 2. hypovolemic shock; 3. metabolic acidosis; 4. hypoalbuminemia. Other laboratory data were not significant.

>>The patient was admitted to the pediatric intensive care unit. Fluid resuscitation, antibiotics, analgesic therapy, wound dressing change, and enteral feeding were started immediately.

>>On the third day of admission, X-ray suggested that the neonate was suffering from pneumonia with severe respiratory acidosis. Thus, ventilator assisted ventilation following with vancomycin and meropenem were applicated. The ventilator was removed on the sixth day after admission as his respiratory condition gradually improved. Vancomycin and meropenem were continued to use, considering the infection of both Gram-positive and Gram-negative bacteria by airway secretion culture. Besides, the blood supplies of the left-hand fingers were poor, and there was no sign of healing. Dressing changes in burned areas were continued to perform once a day with nano-silver and povidone-iodine. However, the necrosis progressed intensely.

>>The patient was suffered from severe pneumonia. Also, the scope and extent of the lesion were not clear. As the risk of anesthesia, intraoperative and postoperative complications are incredibly high for this patient with severe pneumonia, and on the other hand, considering the scope and extent of the lesion is not clear, we decided to improve the general condition of the patient and wait for the MR scan to determine the scope and extent of the lesion. In the meanwhile, conservative treatments such as wound dressing were continued. Dressing changes in burned areas were performed once a day using nano-silver and povidone-iodine.

>>On the eleventh day after admission, the patient’s general condition was improved. MR scan result suggested that the lesion was limited to the skin. However, the wound still showed no sign of healing. The necrotic part on his face, chest, and left hand is prominent. Also, movement of the thumb and index finger of the left hand was restricted (Fig. 2). According to the MR scan result and current condition, we decided to perform the surgery on the same day. Amputation of the distal segment of the thumb and middle segment of the index finger of the left hand was performed. Excision of the auricle and escharotomy of face, chest, and left hand were also performed. An intermediate-thickness skin graft of 0.3 mm was harvested and calibrated by the Air-Zimmer electric dermatome from his right lower limb. The lesions on his face, chest, and left-hand were covered with autograft islet.

>>Grafted skin was growing well on the fifth day after surgery (Fig. 3). After surgery, the amount of urine is gradually decreased with the increased of serum creatinine and vancomycin plasma concentration, suggesting renal failure due to the use of vancomycin. Thus, we replaced vancomycin with linezolid, and the renal function was gradually improved. On a ninth day after surgery, all the grafted burn wounds were almost healed, and the neonate was discharged for regular follow-up. On the thirtieth day after surgery, the burn areas were fully recovered (Fig. 4), and long-term follow-up visits were scheduled to assess possible adverse scarring in the future.