750 mg VLBW female baby born at 30weeks of gestation , via SNVG(spontaneous normal vaginal delivery) , she admitted to NCU due to RDS , and received iv fluid (10%G/W) with CA gluconate and iv antibiotics via left hand dorsum cannula
on the following morning , her left hand was swollen with some redness , iv fluid stopped immediately , cannula removed , hand elevated with frequent warm packing
on the next day , her injury progressed to necrotic patch (2.5cm x 2.5cm) with some intact blisters , in the same day , blisters were punctured accidentally and serosanguineous discharge was oozing from it
on further examination , her hand was erythematous , tender , swollen , fingers pink and her pulses were intact with normal capillary refilling time (2seconds)
the treatment consisting of irrigation with normal saline , using mupirocin ointment with frequent sterile dressing in addition to frequent warm sponging
after 2 days , her injury was progressed and become more ulcerated (1) , here pulse still intact , doppler U/S of her limb was normal , her antibiotics changed to anti pseudomonal and anti staph (including MRSA) with serial monitoring of her renal function
in addition , daily sterile dressing after irrigation with N/S and applying of mupirocin ointment were continued until the erythema and ulcerated lesion resolved , her injury was completely healed on day 30(picture 3)
notes regarding this case :
1-extravasation injury is common in neonate (especially preterm and low birth weight )due to smaller caliber vessels and poor venous integrity , the cornerstone in the treatment of this injury is stopping the fluid earlier and removal of cannula if necessary ,
2-any delaying in the treatment can lead to more serious complications as compartment syndrome and even amputation
3-topical nitroglycerine 2% ointment if available , it is better to be avoided especially in preterm newborns who have immature skin and limited autoregulation of blood flow and therefore they will be at increased risk of brain hemorrhage