Innovative use of DACC Technology in Neonatal Care of Multiple Fistulae

An extremely premature neonate, 23 weeks gestation, was admitted to a Mid-Western tertiary referral children's hospital. Weighing just 1000 grams at 25 weeks, co-morbidities included respiratory failure, polymicrobial sepsis, renal failure, and newly-developed Necrotizing entercolitis (NEC) with diffuse peritonitis. Surgery was performed to create an end ileostomy, however an unstable post-op course and worsening hepatic dysfunction complicated healing and nutrition. Abdominal distension continued and bowel strictures were discovered which required another surgery at 30 weeks gestation. During this six hour surgery enterotomies were made while lysing adhesions. A mesh graft covered over an open distended abdomen and was sewn to fragile tissue. Multiple fistulas began to mature and drain bile resulting in frequent pouch changes and deterioration of the graft. Various dressing and pouching techniques were tried by bedside nursing until pouching became extremely challenging resulting in numerous daily changes. This neonate’s condition deteriorated with further complications and central-line related blood stream infections. Multiple fistula across a small abdomen with limited skin space posed a pouching challenge.  Peristomal skin was abused by the intestinal effluent, bloody mucous drainage and constant adhesive removal. DACC (Dialkylcarbamoyl chloride) technology was tried on the friable peri-stomal skin. This cellulose coated dressing irreversibly binds with bacteria through hydrophobic action and decreases bioburden. Hydrocolloid paste was molded to fit around the stomas.  An adult- size wound manager was cut to fit around the abdominal stomas. To help maintain the drainage, a red rubber catheter was used in the wound manager and connected to low intermittent suction. This pouching system and DACC dressing was changed twice per week by the CWOCN. The peri wound skin began forming epithelial tissue and no further central line infections developed after implementation of the DACC dressing and wound manager.  On day 233, multi-system organ failure contributed to loss of life.