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A 32 week gestation neonate was born September 8th2011. Three weeks later was diagnosed with necrotizing enterocolitis (NEC); underwent surgery and found to have extensive gangrenous bowel with hemorrhage. The following day, this neonate’s abdominal wound perforated. Later that evening, a laparoscopic massive enterectomy of the small and large bowel was performed. The entire duodenum (minus ~ 2cm) and entire ileum including ileocecal valve was resected. Only 31cm of jejunum remained, resulting in a colostomy and distal and proximal jejunostomy.
On October 10ththe abdominal wound dehisced and wet to dry dressings were initiated. The neonatal intensive care unit (NICU) nurses were unable to contain the heavy, foul drainage so they began changing dressings between care sessions. This significantly compromised the neonate’s skin integrity and disrupted the environmental factors that affect growth (sound, light, heat and pain). Orders were changed to alginate dressings with crusting to the periwound at every other care session. However the dressing saturated within four hours.
The WOC nurse held a meeting with the neonatal physicians, nurse practitioners and managers to discuss negative pressure wound therapy (NPWT). Subsequently, the WOC nurse was invited to provide the NICU staff with NPWT education. NPWT was initiated to the abdominal wound using baby bottle nipples “cut to fit” to protect the stomas and allow application of pedi-pouches.
The NPWT dressing and ostomy appliances were changed every Monday, Wednesday and Friday, permitting the neonate to thrive. The abdominal wound healed in ten days, allowing for a better plane for stoma pouching. The neonate’s ostomies were successfully reversed January 2012.
NPWT assisted in wound closure, allowed for a better plane for ostomy pouching, protected the peristomal skin and decreased the environmental factors that could have inhibited the neonate’s growth.