Negative Pressure Wound Therapy in a Neonate with a Complex Abdominal Wound
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Index: WOUNDS. 2013;25(1):E1-E4.
Abstract: Negative pressure wound therapy (NPWT) is used successfully in managing abdominal wounds in neonates, but wounds with stomas present additional challenges. This case study evaluates the effectiveness of NPWT on such a wound, using pediatric urine collection bags to manage stoma output. Methods. Negative pressure wound therapy was applied to a dehisced abdominal surgical wound, located between a jejunostomy stoma and mucous fistula, along with separate pediatric urine collection bags for each stoma. Results. The wound had sufficiently healed after 14 days. Conclusion. Neonatal abdominal wounds, in the presence of stomas and fistulae can be effectively treated with NPWT when separate collection bags are used.
Negative pressure wound therapy (NPWT) has been used successfully in the management of complex abdominal wounds in infants and neonates. Abdominal wounds with stomas and fistulas present the additional challenge of managing the stoma output and working with a much smaller surface area on which to apply an NPWT dressing. A review of the literature does not demonstrate widespread use of NPWT in the presence of a fistula in the neonatal population. In fact, it has been suggested that NPWT can cause a fistula.1,2 This has not been the authors’ experience in their facility, where NPWT has been used extensively on a variety of wounds, including abdominal wounds, in the adult and pediatric population since 1998 without the occurrence of a fistula during treatment. In the authors’ facility, a stoma pouch used in conjunction with NPWT has been widely used in the adult population as found in the literature.3-6 If the wound bed is thought to be compromised, a nonadherent barrier is utilized for protection with the NPWT dressing. However, this same practice is limited in the neonatal population as even pediatric stoma bags or drainage pouches (Wound Manager Sterile Drainage Pouch with Durahesive Skin Barrier™, Convactec, Skillman, NJ) are often too large for the surface area. This report describes 1 method of treating a complex abdominal wound in the presence of a jejunostomy stoma and a mucous fistula in a neonate with a complicated medical history, and provides an example of the positive outcomes experienced with treating such a complex abdominal wound.
This case study describes the effectiveness of NPWT on a complex abdominal wound with a jejunostomy stoma and a mucous fistula using 2 separate pediatric urine collection bags in a neonate with multiple co-morbidities.
Material and Methods
The subject was a premature infant male born at 32 weeks gestation via emergent cesarean delivery due to suspected placental abruption. The patient’s pertinent history included low birth weight (1450 g), respiratory distress syndrome (RDS), metabolic acidosis, significant perinatal asphyxia resulting in multiorgan dysfunction, neonatal hypoglycemia, gastrointestinal bleeding, and pneumoperitoneum. On day of life (DOL) 8, the subject was taken to the operating room for an exploratory laparotomy where a large perforation in the ileum and a small perforation in the jejunum were identified, as well as multiple areas of patchy ischemia throughout the small intestine. The enterotomy in the proximal jejunum was repaired and 3 cm of small bowel were resected in the ileum. A 6 cm silicone ventral wall defect silo bag was placed. On DOL 9, the patient returned to surgery where an 8 cm area of ischemic mid-to-distal jejunum required resection and jejunostomy with mucous fistula.