Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant

Mannan, Khalid; Chow, Peter; Lissauer, T.; Godambe, Sunit

doi:10.1111/j.1651-2227.2007.00376.x

Cited by 48 publications

(28 citation statements)

References 6 publications

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“…Upadhyayula and colleagues also had similar experiences with alcoholbased chlorhexidine. 5 Mannan and colleagues, 6 Brinqué Espuny and colleagues, 7 and Reynolds and colleagues 8 describe similar events with 0.5 percent chlorhexidine in 70 percent alcohol. The authors describe full thickness burns to skin exposed to these preparations.…”

Section: The Risk Associated With Chgmentioning

confidence: 66%

Neonatal Skin and Chlorhexidine: A Burning Experience

Kutsch¹,

Ottinger²

2013

Neonatal Network

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Section: The Risk Associated With Chgmentioning

confidence: 66%

Neonatal Skin and Chlorhexidine: A Burning Experience

Kutsch¹,

Ottinger²

2013

Neonatal Network

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“…Newborns sustain full-thickness burns from thermal insults, which may result in superficial thickness burns in older children, and preterm infants have major risks in term of morbidity and wound management. 64 Neonatal skin has peculiar absorption characteristics, with high permeability to topical agents. In the early neonatal period, there is a marked topical drug absorption and high skin water loss because of incomplete development of the stratum corneum.…”

Section: Discussionmentioning

confidence: 99%

Skin Physiology of the Neonate and Infant: Clinical Implications

Oranges

Dini

Romanelli

2015

Advances in Wound Care

160

129

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Significance:The skin is a complex and dynamic organ that performs several vital functions. The maturation process of the skin starts at birth with the adaption of the skin to the comparatively dry environment compared to the in utero milieu. This adaptive flexibility results in the unique properties of infant skin. To deliver appropriate care to infant skin, it is necessary to understand that it is evolving with unique characteristics. Recent Advances: The role of biophysical noninvasive techniques in the assessment of skin development underlines the importance of an objective evaluation of skin physiology parameters. Skin hydration, transepidermal water loss, and pH values are measurable with specific instruments that give us an accurate and reproducible assessment during infant skin maturation. The recording of these values, following standard measurement procedures, allows us to evaluate the integrity of the skin barrier and to monitor the functionality of the maturing skin over time. Critical Issues: During the barrier development, impaired skin function makes the skin vulnerable to chemical damage, microbial infections, and skin diseases, possibly compromising the general health of the infant. Preterm newborns, during the first weeks of life, have an even less developed skin barrier and, therefore, are even more at risk. Thus, it is extremely important to evaluate the risk of infection, skin breakdown, topical agent absorption, and the risk of thermoregulation failure. Future Directions: Detailed and objective evaluations of infant skin maturation are necessary to improve infant skin care. The results of these evaluations should be formed into general protocols that will allow doctors and caregivers to give more personalized care to full-term newborns, preterm newborns, and infants. SCOPE AND SIGNIFICANCEThe skin of preterm newborns, full-term newborns, and infants undergoes a characteristic process of maturation, and therefore, skin care delivered to this spectrum of patients needs to be tailored to the individual patient. The principal aims of safe and effective skin care are to identify the agents that can influence the skin barrier or those that can induce systemic toxicity and avoid their utilization, thereby minimizing the risk of thermoregulation failure, which will protect newborns against potential skin breakdown and loss of its barrier function. TRANSLATIONAL RELEVANCEMany studies have correlated functional infant skin parameters according to age, anatomical site, and the presence of skin or systemic disease. It would be useful to study how these functional parameters change in newborns after the onset of skin infection, skin breakdown, or the application of topical agents. The results of these evaluations could be formed into general protocols, which will allow doctors and wound care providers the ability to give more personalized care to full-term newborns, preterm newborns, and infants. CLINICAL RELEVANCEUnderstanding the characteristics of newborn and infant skin will permit the delivery of a...

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“…Alcohol-based skin cleansers such as chlorhexidine gluconate (0.5% in 70% methanol) are widely used before insertion of umbilical and percutaneous central lines for achieving skin sterilization in neonates [32]. Extensive abdominal burns ( Figure 2) from chlorhexidine/alcohol applied during the insertion of umbilical catheters have been reported [33][34][35][36].…”

Section: Chemical Burnsmentioning

confidence: 99%

Iatrogenic skin injury in the neonatal intensive care unit

Sardesai

Kornacka

Walas³

et al. 2010

The Journal of Maternal-Fetal & Neonatal Medicine

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Although neonatal care has become more and more meticulous with significant changes in technology in the neonatal intensive care unit (NICU) in the past 50 years, iatrogenic cutaneous injuries continue to occur. Although the incidence of severe injuries is decreasing because the more difficult procedures are being replaced by improved techniques, skin injuries have not yet been completely eliminated. However, the nature and causes of cutaneous injuries have changed, and the injuries are frequent but generally minor. The major risk factors are low birth weight, gestational age, length of stay, a central venous line, mechanical ventilation, and support with continuous positive airway pressure. The rate of iatrogenic events is about 57% at gestational ages of 24-27 weeks, compared with 3% at term. There are no current comprehensive reviews of iatrogenic cutaneous injury. The purpose of this review is to describe the iatrogenic cutaneous injuries that may occur in the newborns as a consequence of perinatal and postnatal medical procedures. With increased survival of extremely-low-birth-weight (ELBW) infants and changing modes of management in the NICU, neonatologists must make every effort to recognize injuries and prevent their occurrence in the NICU.

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Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant

Abstract: The case highlights the importance of having a clear policy for skin cleansing in every neonatal unit and measures to avoid errors by vigilant checking of all medications including topical solutions.

Cited by 48 publications

References 6 publications

Neonatal Skin and Chlorhexidine: A Burning Experience

Neonatal Skin and Chlorhexidine: A Burning Experience

Skin Physiology of the Neonate and Infant: Clinical Implications

Iatrogenic skin injury in the neonatal intensive care unit

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