subcutaneous gangrene of the newborn
Introduction
Introduction to neonatal subcutaneous gangrene Neonatal subcutaneous gangrene is an acute cellulitis, often caused by Staphylococcus aureus, which occurs in the back or lumbosacral area where the newborn is easily stressed, occasionally occipital, shoulder, leg and perineum, and is prone to hair in winter. The skin of the newborn is thin and tender, and the local skin is susceptible to pressure in the winter. It is not easy to keep clean, so the bacteria easily invade from the damaged skin and cause infection. If you do not take active treatment in time, you can have sepsis, bronchitis and lung abscess, so the mortality rate is higher. basic knowledge The proportion of illness: 0.001% Susceptible people: seen in newborns Mode of infection: non-infectious Complications: sepsis toxic shock syndrome
Cause
Neonatal subcutaneous gangrene
Poor skin defense (30%):
Newborn skin is thin and tender, skin defense ability and response to inflammation are poor, lymph node barrier function is not perfect, local skin is vulnerable to pressure in winter, it is difficult to keep clean, so bacteria easily invade from damaged skin, causing infection.
Bacterial infection (25%):
Newborns are highly susceptible to bacterial infections and subcutaneous gangrene. Infected bacteria are often Staphylococcus aureus, and occasionally Pseudomonas aeruginosa, Streptococcus viridans and so on. In the case of concurrent sepsis, blood culture can produce positive results.
Physical stimulation (23%):
The long-term supine position of the newborn, the abrasion of the clothes, the impregnation of the urine or the crying of the urine can induce local skin damage and allow the bacteria to invade.
Prevention
Neonatal subcutaneous gangrene prevention
It is necessary to do a good job in the sanitary work of the newborn bedroom. The indoor ventilation should be 2-3 times a day to avoid convective wind. When cleaning the ground, the wet scrub should be used to prevent the respiratory tract from contacting the newborn. The contact must wear a mask and pay attention to the newborn. Clean the skin, take a daily bath, change the diaper frequently, rinse with warm water, and apply a citric acid ointment to prevent red buttocks.
The diaper strives to be soft and prevent skin abrasion; timely replace the diaper contaminated by urine and feces, and clean the buttocks skin after the feces; pay attention to the disinfection of the delivery room, baby room and baby equipment, respiratory infections (parents, staff) should be temporarily avoided with the baby Contact, protect the baby's health, the clothes should be wide and soft, the diaper should be easy to absorb water and soft, to prevent the baby from rubbing the delicate skin.
Complication
Neonatal subcutaneous gangrene complications Complications sepsis toxic shock syndrome
1. Bronchitis.
2. Lung abscess.
3. Septicemia.
4. Toxic shock.
5. Respiratory failure.
6. Renal failure.
Symptom
Neonatal subcutaneous gangrene symptoms Common symptoms Toe skin blackening high heat skin necrosis diarrhea jaundice abdominal distension dyspnea anorexia dehydration
Local symptoms
Occurs in the body compression site, more common in the buttocks and back, occipital, ankle, neck, leg and perineum can also occur, which is characterized by:
(1) The onset is urgent, the local skin temperature is increased, it is red, slightly swollen, hard and the boundary is unclear; the acupressure site becomes white.
(2) Separation of skin and subcutaneous tissue: The lesion spreads rapidly within a few hours, and can spread to most or the whole back within 1 day. The skin becomes soft, the color of the central area turns dark red, and the subcutaneous tissue is necrotic, but the pus is not much. The skin is separated from the subcutaneous tissue, palpation is floating, and there is little fluctuation.
(3) skin necrosis: due to skin and subcutaneous intravascular thrombosis, skin necrosis, some children have multiple blisters on the skin, and gradually merge, the contents turned into bloody liquid; the central part of the skin turned black, gradually increased Large necrotic area.
2. Systemic symptoms
It is characterized by high fever, crying, refusal of milk, or vomiting, diarrhea, body temperature of 38 ~ 39 ° C, the highest can reach 40 ° C, combined with sepsis, high fever, drowsiness, cyanosis, difficulty breathing, abdominal distension, skin jaundice, There are bleeding spots. In severe cases, the body temperature does not rise, toxic shock occurs, and death is caused by respiratory and renal failure.
(1) 6-10 days after birth, the lumbosacral region, back, buttocks are often good sites, but also in the perineum, head and neck, neck, shoulders, chest and other parts of the disease.
(2) The lesion begins, the skin is extensively congested and swollen, the edge is unclear, slightly hard, the onset is acute, and the development is rapid, and then the subcutaneous tissue is necrotic, separated, liquefied, red and swollen, the center is dark red, and the floating feeling is feature.
(3) Late skin is dark purple, and spots or flaky necrosis occur.
(4) The body may have high fever, crying, anorexia and other symptoms of infection, but also bloating, vomiting, dehydration and so on.
Examine
Examination of neonatal subcutaneous gangrene
The body should be carefully and thoroughly examined. In particular, check the waist, ankle, hip, back and other compression parts. If you find that the local skin has unclear redness, you should seek medical attention immediately.
Peripheral blood
(1) White blood cell count: The white blood cell count is increased.
(2) White blood cell differential count: neutrophil increased.
2. Bacteriology examination
(1) Smear examination: Gram staining is performed on the secretions or serum around the skin edge, which is helpful for identifying bacterial species.
(2) Bacterial culture: The cultured secretions or serum are cultured, mostly Staphylococcus aureus.
(3) Drug sensitivity test: it has a guiding role in clinical treatment.
Diagnosis
Diagnosis and diagnosis of subcutaneous gangrene in newborns
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
1. History: history of long-term compression or urinary faecal soaking in the body; history of contact with unclean items; history of contact with people with respiratory infections.
2. Local characteristic performance: the body is under pressure or urine, the skin of the fecal infusion is unclear red, swollen, hard, with fever and abnormal behavior of the baby; or the skin is dark red, touching the skin with floating feeling, or under the skin A sense of emptiness.
3. Laboratory examination.
Differential diagnosis:
Pay attention to the identification of diaper rash and scleroderma, the red cloth of the diaper rash is not swollen, the skin of scleroderma is swollen and not red, and both have no systemic symptoms of infection.
1. Diaper rash: The skin of diaper rash is red and no swelling.
2. Scleroderma: The skin is swollen and hard, not red, mostly with stiff upper limbs and no systemic symptoms of infection.
3. Erysipelas: extensive erythema in the ward, clear boundary, slightly higher than the surrounding skin surface, no floating feeling, rarely occurs in newborns.
