Irrigación con solución salina para el tratamiento de la lesión por extravasación de la piel en los recién nacidos
Información
- DOI:
- https://doi.org/10.1002/14651858.CD008404.pub3Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 19 julio 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neonatología
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
S Banerjee conceptualised this review and was involved in all stages and guided preparation of this review.
N Goel contributed to the literature search, study selection, data management, communications, and development of the Discussion and Conclusions, and was involved in all stages of preparation of this review.
PN Gopalakrishnan contributed to the literature search, study selection, data management, communications, and development of the Discussion and Conclusions, and was involved in all stages of preparation of this review.
Sources of support
Internal sources
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Library Services, Singleton Hospital, ABM University NHS Trust, Swansea, UK.
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Department of Neonatology, Singleton Hospital, ABM University Health Board, Swansea, UK.
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Library Services, Glan Clwyd Hospital, UK.
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Library Services, NHS Lanarkshire, UK.
External sources
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Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.
Editorial support of the Cochrane Neonatal Review Group has been funded by Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C
Declarations of interest
We have no interests to declare.
Acknowledgements
Ms Diane Haughton (former Review Group Co‐ordinator, Cochrane Neonatal).
Dr R Soll (Co‐ordinating Editor, Cochrane Neonatal).
Dr J Sinclair.
Dr J Horbar.
Prof M Bracken.
Dr G Suresh.
Dr A Ohisson.
Ms Eryl Smith (Library Services ‐ Glan Clwyd Hospital, UK).
Ms Susan Prosser (Library Services ‐ Singleton Hospital, UK).
Ms Yolanda Montagne (Trial Search Co‐ordinator, Cochrane Neonatal).
Ms Jennifer Spano (Cochrane Neonatal).
Ms Colleen Ovelman (Managing Editor, Cochrane Neonatal).
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Jul 19 | Saline irrigation for the management of skin extravasation injury in neonates | Review | P N Gopalakrishnan, Nitin Goel, Sujoy Banerjee | |
| 2012 Feb 15 | Saline irrigation for the management of skin extravasation injury in neonates | Review | P N Gopalakrishnan, N Goel, Sujoy Banerjee | |
| 2010 Mar 17 | Saline irrigation for the management of skin extravasation injury in neonates | Protocol | P N Gopalakrishnan, N Goel, Sujoy Banerjee | |
Differences between protocol and review
We have no deviation from the original protocol to report.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans; Infant, Newborn;
PICO
Study flow diagram: review update.
| Saline irrigation with or without prior infiltration of hyaluronidase vs standard wound care for management of extravasation injury in neonates | ||||||
| Patient or population: neonates requiring management of extravasation injury | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Risk with standard wound care | Risk with saline irrigation with or without prior infiltration of hyaluronidase | |||||
| Complete wound healing after saline irrigation with or without prior hyaluronidase infiltration (wound healing): clinical assessment | Study population | Not estimable | 237 | ⊕⊝⊝⊝ | Pooled data for 237 neonates from 10 case report studies who underwent saline irrigation. Three neonates received further surgical intervention. For 234 neonates, complete wound healing was reported | |
| 0 per 1000 | 0 per 1000 | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI) | ||||||
| GRADE Working Group grades of evidence | ||||||
| All 10 studies analysed in GRADE pro GDT are case reports, and the intervention methods mentioned are highly variable. In view of this, "relative effect (95% CI)" and "absolute effect (95% CI)" were not derived. | ||||||
| Study | Type of study | Number of neonates | Extravasation | Intervention | Outcome |
| Case series | 14 neonates | Dopamine ‐ 9 Caffeine ‐ 2 Calcium ‐ 2 Beta blocker ‐ 1 | Hyaluronidase infiltration and aspiration ‐ 12 Saline irrigation and aspiration ‐ 1 Hyaluronidase infiltration alone ‐ 1 | 3 cases developed skin necrosis but healed spontaneously | |
| Case report | 1 neonate | Total parenteral nutrition (TPN) | Infiltration with hyaluronidase with saline irrigation | Healing in 3 days | |
| Retrospective review of 31 cases | 31 neonates had 36 extravasations | TPN ‐ 13 Medications ‐ 10 Blood products ‐ 6 Crystalloids ‐ 5 Contrast ‐ 2 | Hyaluronidase infiltration and saline irrigation used for 24 extravasation injuries | No surgical graft required | |
| Case report | 2 preterm neonate less than 29 weeks gestation | TPN | Hyaluronidase infiltration and saline irrigation | Minimal or no scarring, no functional sequelae | |
| Retrospective review of 96 cases | Total 96 cases referred to a tertiary plastic surgical unit (age range ‐ preterm neonate to 72 years ‐ exact distribution not mentioned) 44 early referrals, i.e. within 24 hours 52 late referral, i.e. after 24 hours | TPN Inotrope Ca KCl Bicarbonate Dextrose: 10%‐20% Chemotherapeutics Contrast Antibiotics (exact numbers not mentioned) | Early referral group: 44 (saline irrigation alone ‐ 37, liposuction and saline irrigation ‐ 6, liposuction alone ‐ 1) Late referral group: wound and surgical management | Early referral group: 39 (88.5%) no soft tissue damage, 5 (11.5%) minor skin blistering Late referral group: 8 (15%) healed without tissue necrosis, 17 (33%) minor skin sloughing, 27 (52%) extensive damage to tissues ‐ 3 amputations | |
| Retrospective review | 56 neonates | TPN Inotrope Calcium Potassium chloride Sodium bicarbonate High concentration of dextrose (exact numbers not mentioned) | Saline irrigation alone | No skin loss. None required reconstructive surgery | |
| Case report | 34 neonates | TPN ‐ 28 10% dextrose ‐ 4 Second‐generation cephalosporin ‐ 2 | Saline irrigation followed by topical application of paraffin‐impregnated gauze and povidone‐iodine‐soaked gauze dressing | In 21 infants, no signs of soft tissue damage by 24 hours of treatment Minor findings still present for a few days in 7 patents after treatment Ischaemic signs present in 6 patients subsided within 25 days | |
| Case report | 1 neonate | Antibiotics | Infiltration with recombinant human hyaluronidase (rHuPH20) | Wound healed completely by 8 days | |
| Case report | 1 neonate | Dobutamine, adrenaline, 8.4% sodium bicarbonate, 10% calcium gluconate | Infiltration of hyaluronidase followed by liposuction and saline irrigation | No signs of soft tissue damage at 2 weeks | |
| Case report | 1 neonate | TPN | Hyaluronidase infiltration and saline irrigation | Healed fully by 5 days |
| Study | Stage of extravasation | Intervention | Outcome | Reason for exclusion |
| Skin necrosis (stage 3): n = 3 Swelling, oedema, discolouration (stage 1‐2): n = 11 | Hyaluronidase and aspiration ‐ 12 cases Hyaluronidase infiltration alone ‐ 1 Saline irrigation and aspiration ‐ 1 Treatment allocation not specified by stage of injury | No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Swelling, erythema, and induration (stage 3): n = 1 | Hyaluronidase and saline irrigation | No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Erythema and oedema (stage 1‐2): n = 12 Skin necrosis (stage 3): n = 24 | Stage 1‐2 ‐ standard wound management Stage 3 ‐ hyaluronidase and saline irrigation | No sequelae No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Skin necrosis (stage 3): n = 2 | Hyaluronidase and saline irrigation | Minimal scarring, no sequelae | Neither a randomised nor a quasi‐randomised study | |
| Skin necrosis (stage 3): Early referral: n = 44 Delayed referral (stage 3‐4): n = 52 | Stage 3: Saline irrigation alone: n = 37 Liposuction and saline irrigation: n = 6 Liposuction alone: n = 1 Stage 3‐4: Wound debridement and surgical flap | No sequelae 8 (15%) healed without tissue necrosis, 17 (33%) minor skin sloughing, 27 (52%) extensive damage to tissues ‐ 3 amputations | Neither a randomised nor a quasi‐randomised study | |
| Exact stage of extravasation injury not specified: n = 56 | Saline irrigation | No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Stage 3 and stage 4 extravasation | Saline irrigation within 30 minutes of extravasation injury | None of the wounds needed secondary skin coverage procedures | Neither a randomised nor a quasi‐randomised study | |
| Discolouration, oedema, cool, pulses not palpable (stage 4): n = 1 | Infiltration with recombinant human hyaluronidase (rHuPH20) | No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Oedema, pallor, cold, and no capillary filling | Infiltration with hyaluronidase, liposuction, and saline irrigation | No sequelae | Neither a randomised nor a quasi‐randomised study | |
| Skin necrosis (stage 3): n = 1 | Hyaluronidase and saline irrigation | No sequelae | Neither a randomised nor a quasi‐randomised study |
