Successful Combined Treatment with Total Parenteral Nutrition Fluid Extravasation Injuries in Preterm Infants

Cho, Ky Young; Lee, Soo Jung; Burm, Jin Sik; Park, Eun Ae

doi:10.3346/jkms.2007.22.3.588

Cited by 17 publications

(11 citation statements)

References 19 publications

(21 reference statements)

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“…In the present study, MEBO, a Chinese herbal ointment, promotes granulation tissue formation and reduces the time of wound healing in cutaneous excisional wounds, suggesting that it is effective for wound healing, which is consistent with the results of previous studies (34,35,38). It is well established that excisional wounds invariably destroy tissue integrity, and lead to vascular injury and fibrin-fibronectin clot formation, thus leading to platelet recruitment, and subsequently upregulation of growth factors and cytokines, including VEGF and bFGF (5,39), which triggers the formation of granulation tissue and wound healing.…”

Section: Discussionsupporting

confidence: 81%

Moist exposed burn ointment promotes cutaneous excisional wound healing in rats involving VEGF and bFGF

Tang

Han

Feng

et al. 2014

Molecular Medicine Reports

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Abstract. Cutaneous delayed wounds are a challenging clinical problem, and vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) exhibit key roles in wound healing. Moist exposed burn ointment (MEBO), a Chinese burn ointment with a USA patented formulation, has been reported to promote chronic ischemic and neurogenic ulcer healing in patients; however, the underlying mechanisms remain unclear. In the present study, MEBO significantly promoted the formation of granulation tissue in cutaneous excisional wounds, shortened the time of wound healing, and increased neovascularization and the number of fibroblasts. Furthermore, as well as enhancing the protein expression, MEBO application also increased the gene expression of VEGF and bFGF. The results indicate that MEBO promotes cutaneous excisional wound healing by at least partially enhancing VEGF and bFGF production, implicating the potential uses of MEBO for delayed cutaneous wound healing. IntroductionCutaneous wounds, known as ulcers, are an extremely common clinical problem and often arise following acute or chronic mechanical causes, physical or chemical burns, frostbite, infections, and disorders, including rheumatism, diabetes, peripheral vascular disease, lipodermatosclerosis and malignant tumors (1,2). Furthermore, cutaneous wound healing may be significantly delayed due to the aforementioned factors. At present, delayed cutaneous wounds are one of major burdens for health care, and lead to a reduced quality of life in patients who suffer from this type of wound (3,4).Wound healing is a complicated biological process involving a series of dynamic events, including hemostasia, inflammation, cell proliferation and differentiation, neovascularization, granulation tissue formation, collagen synthesis, epithelialization, and wound contraction. Increasing evidence has established the hypothesis that growth factors, including vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), are key regulators of normal and abnormal angiogenesis, and tissue repair in animals and humans (5-8). VEGF promotes angiogenesis/vasculogenesis and vascular permeability, and enhances endothelial cell proliferation and migration as well as the adhesion of leukocytes (5,9). Further research revealed that VEGF stimulates hydrogen sulfide synthesis and release from endothelial cells, thus leading to subsequent endothelial cell growth, migration and permeability, microvessel formation, and wound healing (10). In addition, VEGF promotes epithelialization and collagen deposition in the wound (11). FGF-2, known as bFGF, is a member of a large FGF family and induces angiogenesis, endothelial cell and fibroblast proliferation, and wound healing (12)(13)(14). Recent data indicated that bFGF-mediated angiogenesis refers to endothelial cell proliferation, migration and tube formation by activating c-Jun N-terminal kinase/stress-activated protein kinase signaling (15). Notably, the expression of VEGF and bFGF was increased following skin in...

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Section: Discussionsupporting

confidence: 81%

Moist exposed burn ointment promotes cutaneous excisional wound healing in rats involving VEGF and bFGF

Tang

Han

Feng

et al. 2014

Molecular Medicine Reports

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“…However, evidence regarding the most appropriate protocol to minimize damage due to extravasation events is insufficient. Only a few studies have suggested wound manage procedures [8,[13][14][15][16][17]. Extravasation events involve severe complications such as the progression of a relatively mild wound (tissue edema, redness, or vasculitis) to skin necrosis or an abscess [18].…”

Section: Original Articlementioning

confidence: 99%

Extravasation Wound Care in the Neonatal Intensive Care Unit

et al. 2019

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Background: Extravasation injuries occurring in neonates can have severe consequences. Because many clinicians are not familiar with the vesicant-like effect of several commonly used medications, early extravasation wound management can be difficult. We aimed to share our experience with irritant-related and vesicant-related injuries leading to neonatal extravasation wounds. Methods: This retrospective study included 36 premature neonatal patients with extravasation wounds. Patients were classified into four groups based on extravascular staging and clinical wound conditions. We compared groups according to the following factors: sex, birth weight, prematurity, wound healing duration, days since the intravenous line was placed, wound severity, use of antibiotics, complications, treatment, type of intravenous fluid, and intravenous cannulation sites. Results: Neonatal birth weight was proportional to wound severity. Except in cases involving necrosis wounds, the lesion size increased with severity. Extravasation events occurred an average of 3.2 days after cannulation. Neonatal parenteral nutrition formulas and antibiotics acted as vesicants. Conclusion: Intravenous cannulation sites must be closely monitored in neonates, particularly during the first 3 days after cannulation. Monitoring is particularly important for larger neonates because intravenous fluid is administered based on body weight. Detailed knowledge about the vesicant fluid is required.

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“…62,64,70,75,79,87,102,104,[108][109][110][111]121,123,129,147,148,153,157,[159][160][161][162] In total, 163 individual participants were studied. Study characteristics are summarised in Table 7 with full treatment, intervention and outcome details presented in Appendix 3.…”

Section: Case Report Studiesmentioning

confidence: 99%

Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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BackgroundExtravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.ObjectivesTo identify which treatments may be best for treating extravasation injuries in infants and young children.DesignScoping review and survey of practice.PopulationChildren aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.InterventionsAny treatment for extravasation injury.Main outcome measuresWound healing time, infection, pain, scarring, functional impairment, requirement for surgery.Data sourcesTwelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).MethodsScoping review – studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.ResultsThe evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.LimitationsPaucity of good-quality studies.ConclusionsThere is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.Future workConventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Successful Combined Treatment with Total Parenteral Nutrition Fluid Extravasation Injuries in Preterm Infants

Cited by 17 publications

References 19 publications

Moist exposed burn ointment promotes cutaneous excisional wound healing in rats involving VEGF and bFGF

Moist exposed burn ointment promotes cutaneous excisional wound healing in rats involving VEGF and bFGF

Extravasation Wound Care in the Neonatal Intensive Care Unit

Treatment of extravasation injuries in infants and young children: a scoping review and survey

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