Saline irrigation for the management of skin extravasation injury in neonates

Preterm and sick term infants requiring intravenous fluids and medications are vulnerable to tissue injury secondary to extravasation that is, leakage of fluid into the surrounding tissue. Such injury can result in scarring with consequent cosmetic issues and, in some infants, functional limitation. Remedial surgical intervention may be required for some babies. Saline flush out, with or without prior infiltration of hyaluronidase (a protein that helps the breakdown of barriers that hold tissue planes together), is widely used in the management of severe extravasation injury in neonates and aims to prevent or reduce complications following the extravasation. Conservative treatment with normal wound care and various topical dressings is commonly used. We planned to examine if saline flush out with or without prior hyaluronidase infiltration into the injured area resulted in better short and long-term cosmetic and functional outcomes when compared to normal wound care. We did not find any study that currently answers this question.

Authors' conclusions: 

To date, no randomised controlled trial is available that examines the effects of saline irrigation with or without prior hyaluronidase infiltration in the management of extravasation injury in neonates. Saline irrigation is a frequently reported intervention in the literature that is used in the management of extravasation injury in neonates. Research should be initially directed at evaluating the efficacy and safety of this intervention through randomised controlled trials. It will also be important to determine the size of the effect according to timing of intervention, nature of the infusate and the severity of injury at the time of intervention.

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Background: 

Extravasation injury is a common complication of neonatal intensive care and can result in scarring with cosmetic and functional sequelae. A wide variety of treatments are used in practice including subcutaneous irrigation with saline (with or without hyaluronidase), liposuction, use of specific antidotes, different topical applications and normal wound care with dry or wet dressings. All such treatments aim to prevent or reduce the severity of complications.

Objectives: 

To determine the efficacy and safety of saline irrigation or saline irrigation with prior hyaluronidase infiltration on tissue healing in neonates with extravasation injury when compared to no intervention or normal wound care.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to June 2011), EMBASE (Jan 1980 to June 2011), CINAHL (Jan 1988 to June 2011) and the Web of Science (up to July 2011).

Selection criteria: 

Randomised controlled trials (RCT) and quasi-randomised controlled trials comparing saline irrigation with or without hyaluronidase infiltration with no intervention or normal wound care in the management of extravasation injury in neonates.

Data collection and analysis: 

Three review authors independently reviewed and identified articles for possible inclusion in this review.

Main results: 

No eligible studies were found. There were a few case reports and case series describing successful outcomes with different interventions in this condition.

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