Comparison of Negative Wound Pressures in Children

Background: Negative pressure wound therapy (NPWT) was first described almost two decades ago for the management of difficult to close wounds. (1). Various studies in adults have demonstrated its efficacy in facilitating wound healing. Due to the retrospective nature of most pediatric studies there is a lack of objective data regarding the amount of pressure that is required.

In adults, a pressure of -125mmHg is recommended. However, pediatric practitioners have been wary of applying adult settings to neonatal and pediatric patients. As a result, lower pressures are frequently selected in children with little evidence to support this practice.

Purpose: The purpose of the this study was to prospectively compare the effect of lower and standard negative wound pressure settings in promoting wound healing in infants and children.

Methods: A prospective, randomized comparative study was conducted at a large, quaternary care pediatric hospital. A block 4 randomization design was used to assign patients to one of two groups: low negative pressure (-50mmHg) or standard negative pressure (-125mmHg or -100mmHg in patients with sternal wounds).

Results: Twenty-five children were randomized to Group 1 (50 mmHg) and 23 children to Group 2 (100 mmHg /125 mmHg). The mean age of the children was 7.39 years. NPWT resulted in closure of 41 of the 49 wounds with an overall volume decrease of 32.21 ± 53.81 cm³ (58.6% reduction).  There was a significant decrease in mean wound volume from 54.94±89.21 cm³ at the start of NPWT to 22.73±53.73 cm³ at the end of therapy (p<0.001). There was no difference in days of NPWT therapy and wound volumes between groups.

Conclusions: Our study suggests that the wound volume contraction between pediatric patients treated with low (-50mmHg) or high (-100/125mmHg) negative pressure settings is similar. These findings suggest that -50 mmHg negative pressure may be adequate in treating complex wounds in pediatric patients.