Dehydrated Amniotic Membrane Allograft: from fetal support to neonatal treatment of severe extravasation injuries

Background: A peripheral IV is placed in 60-70% of NICU infants. Extravasation injuries occur in 18-33%, with 70% of them in extremely preterm babies less than 27 weeks of gestational age. Despite such frequent use of PIV therapy, evidence on best practice, injury prevention, management and treatment of extravasations is less than optimal. Full-thickness injuries, leading to treatment occur in 5-10% of severe neonatal extravasations.

Objective: To describe experience and efficacy of dehydrated amniotic membrane allograft in treatment of severe extravasation injuries in neonatal population.

Methods: We describe case series of 4 preterm, critically ill neonates all with stage 4 extravasations treated with 1 to 2 applications of dehydrated amniotic membrane allograft to facilitate repair process. Prior to treatments standard of care included either enzymatic (Collagenase ointment) or autolytic debridement (Active Leptospermum honey-ALH) followed by mechanical debridement with monofilament polyester fiber lolly prior to allograft placement. Wounds were covered by secondary silicon based non-traumatic dressings. Case1:28 week neonate with right foot extravasation, resulting in full thickness wound to the tendon. 2 applications of amniotic allograft resulted in complete closure by 6 weeks.Case2:31 week male with severe L hand extravasation. 1 application of allograft followed by ALH resulted in complete closure in less than 3 weeks. Case3:25 week female, with right hand full-thickness wound from TPN extravasation. Complete healing was obtained after 1 application. Case 4:24 week male, R hand full thickness wound requiring 1 allograft application.

Results: All patients tolerated allografts; application was easy and follow-up care minimal. All healed without contractures, with minimal soft scars and normal pigmentation at 1-2 month follow-up visits. Photos will be provided.

Conclusion: Dehydrated amniotic membrane allograft is an effective, safe and easy to apply treatment, leading to regeneration and healing of deep neonatal wounds along with anti-scaring effect noted in all wounds.