Effective Negative Pressure Wound Therapy in Premature Infants Using an Alternative Application Technique

Rene Amaya, MD, CWSP, Pediatric Wound Care and Laser Specialists, Pearland, TX
Negative pressure wound therapy (NPWT) is a well-recognized wound care intervention. Its efficacy has also been illustrated in the pediatric population.  In premature infants guidelines for use of NPWT are limited.  Safety is an inherent concern when wound care intervention is applied in this fragile population. Advanced wound dressings and devices may cause additional skin trauma due to the immature nature of their skin. The purpose of this study was to assess the safety and efficacy of an alternative application technique of a NPWT device in premature infants.  It was the author’s hypothesis that this alternative technique would remain effective and more importantly reduce the risk for additional skin trauma in these patients. 

Four premature infant cases are presented.  Patients ranged from 23 to 28 weeks gestation.  Each infant suffered intravenous extravasation injuries resulting in deep full thickness wounds. Injuries arose secondary to extravasation of total parenteral nutrition or antibiotics. Due to significant tissue loss as a result of the extravasation injury, NPWT was initiated to promote granulation.  Due to the diminutive size of these patients and their immature skin, the NPWT device was applied in alternative manner to reduce the amount adhesive film dressing required to attach these bulky devices to their bodies.  Direct contact with the device foam and adhesive dressing was limited to the wound bed itself and tubing and remaining device components were connected away from the patient utilizing simple supplies available in the NICU. This alternative NPWT dressing was replaced every 2-3 days as per standard guidelines. 

In all four cases the NPWT device functioned normally and excellent wound granulation was obtained. No complications were encountered in the infants. This study illustrates the effective use of NPWT in premature infants while focusing on preventing additional injury by utilizing an alternative application technique.