Moisture Related/ Fungal Skin Breakdown under Tracheostomy Device in the Neonate

Purpose: Management of skin breakdown and irritation and fungal overgrowth surrounding tracheostomy tubes.

Issue: Case study directed toward the treatment of candidiasis located under tracheostomy, utilizing soft silver silicone transfer dressing in place of topical, oral, or intravenous antifungal medications.

Clinical Problem: 14 month old female, born at 25 weeks with history of Hydrops secondary to Parvo-virus, Intrauterine Blood Transfusion, Respiratory Distress Syndrome, Bronchopulmonary Dysplasia (BPD), Grade 2 Intraventricular Hemorrhage.The patient has been mechanically ventilation via a tracheostomy tube. Due to the prolonged use of steroids the patient has developed a Cushinoid appearance including increased depth of the neck folds with overlapping skin.Within the neck folds candidiasis formation continued despite meticulous cleansing and changing tracheostomy dressing multiple times a day.

Description of Past Management: Past management included oral antifungals, topical powder and cream formulations of antifungals, and a moisture-wicking fabric with antimicrobial silver.

Current Clinical Approach: A focused individual case study of skin management issues r/t candidiasis was undertaken at WVUH, Children's Hospital. The study utilized a soft silver silicone transfer dressing under the tracheostomy tube to transfer the moisture away from the patients’ neck.

Patient Outcome: Patients case study was completed over a 21 day time frame; assessment, documentation, and photographs taken weekly. Utilizing the clinical guidelines candidiasis resolved with soft silver silicone transfer dressing usage and reoccurance was not evident.

Conclusion: The patient within this case has required prolonged mechanical ventilation via tracheostomy. Infants requiring tracheostomy for airway protection often have anatomical challenges related to the growth & development of the musculature of the head and neck thus creating redundant skin folds prone to fungal overgrowth and skin breakdown. In this case we found a positive correlation to the use of the soft silicone transfer dressings to alleviate those symptoms of candidiasis, skin maceration, and irritation.