Delayed pediatric wound healing due to bacterial colonization: a report of three cases

A common cause of delayed wound healing/ wound dehiscence is colonization with microbes, often leading to infection. Infection can impede the healing process by inducing a strong systemic and local inflammatory response. Critically ill pediatric patients can develop severe illness in response to bacterial endotoxins, systemic inflammatory reaction or antibiotics themselves. Side effects and potential resistance to antibiotics are a real problem in pediatric population; furthermore the effect could be suboptimal due to biofilm formation and poor penetration by antibiotics.

Many “adult” products are contraindicated in neonates due to its side effects. Pediatric population is in great need of less harmful treatment. Studies support the use of non-medicated dressings in managing wound bioburden.

A new concept, hydrophobic interaction, employs fatty acid dialkylcarbamoylchloride (DACC) coated dressing fibers and their ability to interacts with the surface microbes. Microbes, including fungi, are irreversibly bound through the physical mechanism of hydrophobic interaction to DACC coating on the dressing surface. They are removed painlessly during dressing change. The risk of bacterial resistance or sensitization is avoided. Damaging endotoxin release in the wound bed is prevented as well.

We present case series involving neonatal and pediatric patients with delayed wound healing that responded well to dialkylcarbamoylchloride (DACC) coated dressing. We include a newborn with congenital diaphragmatic hernia that developed unstageable pressure ulcers while receiving life-saving ECMO (Extracorporeal Membrane Oxygenation), a 10 yo female with Stage 4 vertebral PU from immobility, infected with Pseudomonas aeruginosa and a 2 wk. old neonate with dehisced thoracic wound after hypoplastic left heart repair. The wounds were treated with DACC coated dressing in combination with 2ry dressing or NPWT device. Dressings were changed according to wound characteristics. Wounds closed successfully. DACC coated dressing represents a unique “bacteria- removing” option without systemic antibiotics/inflammatory response, two factors paramount to avoid in described population.