Negative Pressure Wound Therapy (NPWT) with Normal Saline Instillation in the Neonatal population

Negative Pressure Wound Therapy with instillation (NPWTi) is typically used in cleansing the wound bed rather than moistening a graft. In the neonatal population there is little evidence-based research on negative pressure wound therapy (NPWT) with use of normal saline instillation. Traditional therapy included continuous NPWT to aid in bolstering the graft. “NPWT has revolutionized the management of open wounds by mechanisms of bacteria clearance, moisture elimination, edema reduction, and angiogenesis stimulation” (Evangelista, Kim, Evans, & Wirth, 2013, p.1).  

Through innovative practice three neonates were followed using case study approach to report how normal saline instillation can assist NPWT with bolstering and moistening the graft.  Patient histories included Gastroschisis, Omphalocele and Pentalogy of Cantrell with Omphalocele.  All patients received therapy between 12 and 53 days.  Instillation amount and length of time was titrated based on clinical findings with each dressing change.  Of the three cases, two cases assisted with keeping the graft moist to allow it to regenerate with neonate’s own tissue. 

There continues to be conflicting evidence regarding the benefits of NPWT with normal saline instillation.  Each case provides a unique glimpse into the pros and cons of irrigation, which provides insight into future cases. More opportunities to do further case studies are much needed in order to see if normal saline instillation is an effective adjunctive therapy with NPWT.