The Management of Neonatal Acute Scrotal Necrotizing Fasciitis in a Case and Literature Review

Abstract

Abstract:

Objective: To report the diagnosis and treatment of one neonate with acute necrotizing fasciitis（NF）and explore its
clinical characteristics and key points for treatment with literature review. Methods: Based on the clinical files of this case, the
databases about neonatal acute NF were collected prior to 10th January 2019 from PubMed, METSTR, CNKI, WANFANG and then
literature reviewed. A systematic review of neotatal acute NF was presented. Results: The neonate with scrotal acute NF was cured
successfully by surgery, antibody and antishock therapies and recovered uneventfully with a 9-day hospital stay. A total of 159 articles
in Chinese and English with neonatal NF were retrieved but 184 neonate cases were reported update in 53 articles after excluding the
reviews and cases repeated calculation. There were 93 boys and 91 girls among the 184 cases and 3.5 cases per article in average, but
in only 16 cases the lesion occurred in the perineum including scrotum. After treatment, 115 cases survived with a cure rate of 62.5%
and 69 cases died with a mortality rate of 37.5%. Among the dead, 58 cases died after operation with a postoperative mortality of 33.5%
and the other 11 cases died with conservative treatment. Conclusion: Neonatal NF develops rapidly and is with dangerous prognosis
and high mortality. Prevention and correction of internal environment disorders and anti-infective therapy should be done as soon as
diagnosed and disease progress could be prevented effectively through lesion incision widely and drainage or necrotic tissue clearance
earlier to increase the chances for survival.

Key words: necrotizing fasciitis, prognosis, neonate

CLC Number:

R726

HE Jie, ZHANG Sha-Sha, SHEN Wei, LI Na, LIU Jing-Ling, WANG Ning, TUN Hua-Dong. The Management of Neonatal Acute Scrotal Necrotizing Fasciitis in a Case and Literature Review[J]. , 2019, 4(8): 16-22.

References

〔1〕NARVEY M，BYRNE P，FRASER D. Necrotizing Fasciitis
of the Abdominal Wall in a Premature Infant：A Case
Study〔J〕. Neonatal Netw，2017，36（1）：26-31.
〔2〕KURODA J，INOUE N，SATOH H，et al. Neonatal necro?
tizing fasciitis of the scrotum caused by Streptococcus aga?
lactiae〔J〕. Pediatr Int，2015，57（2）：e56-58.
〔3〕PANDEY V，GANGOPADHYAY A N，GUPTA D K，et al.
Neonatal necrotising fasciitis managed conservatively：An
experience from a tertiary centre〔J〕. J Wound Care，2014，
23（5）：270-273.
〔4〕INOUE S，ODAKA A，HASHIMOTO D，et al. Rare case of
disseminated neonatal zygomycosis mimicking necrotizing
enterocolitis with necrotizing fasciitis〔J〕. J Pediatr Surg，
2011，46（10）：E29-32.
〔5〕WALLS T，WILLIAMS G，ADAMS S，et al. Neonatal necro?
tising fasciitis following superficial skin infection with com?
munity- associated methicillin- resistant Staphylococcus
aureus〔J〕. J Paediatr Child Health，2011，47（12）：918-920.
〔6〕IGNACIO R C，FALCONE R A，WARNER B W. Necrotiz?
ing fasciitis：a rare complication of neonatal necrotizing
enterocolitis〔J〕. J Pediatr Surg，2005，40（11）：1805-1807.
〔7〕ZGRAJ O，PARAN S，O′ SULLIVAN M，et al. Neonatal
scrotal wall necrotizing fasciitis（Fournier gangrene）：a case
report〔J〕. J Med Case Rep，2011，5：576.
〔8〕WEBER D M，FREEMAN N V，ELHAG K M. Periumbilical
Necrotizing Fasciitis in the Newborn〔J〕. Eur J Pediatr
Surg，2001，11（2）：86-91.
〔9〕WAKHLU A，CHAUDHARY A，TANDON R K，et al. Con?                                                                                                                                                             servative management of necrotizing fasciitis in children〔J〕.
J Pediatr Surg，2006，41（6）：1144-1148.
〔10〕SAMUEL M，FREEMAN N V，VAISHNAV A，et al. Nec?
rotizing fasciitis：A serious complication of omphalitis in
neonates〔J〕. J Pediatr Surg，1994，29（11）：1414-1416
〔11〕SAKATA S，DAS GUPTA R，LEDITSCHKE J F，et al. Ex?
tensive necrotising fasciitis in a 4-day-old neonate：a suc?
cessful outcome from modern dressings，intensive care
and early surgical Intervention〔J〕. Pediatr Surg Int，2009，
25（1）：117-119.
〔12〕PEKER E，KIRIMI E，TUNCER O，et al. Necrotizing fasci?
itis caused by Staphylococcus epidermidis in a neonate
with extremely low birthweight〔J〕. J Dermatol，2010，37
（7）：671-673.
〔13〕CHEN J B，SHEN W M，CUI J. Iatrogenic Necrotizing
Fasciitis in a Neonate〔J〕. J Craniofac Surg，2011，22（5）：
1985-1987.
〔14〕THAPA R，MALLICK D，BISWAS B. Necrotizing fasciitis
following BCG vaccination〔J〕. Indian Pediatr，2011，48
（3）：235-237.
〔15〕NEGOSANTI L，ACETI A，BIANCHI T，et al. Adapting a
vacuum assisted closure dressing to challenging wounds：
negative pressure treatment for perineal necrotizing fasci?
itis with rectal prolapse in a newborn affected by acute my?
eloidleukaemia〔J〕.EurJDermatol，2010，20（4）：501-503.
〔16〕BINGÖL-KOLO?LU M，YILDIZ R V，ALPER B，et al.
Necrotizing fasciitis in children：diagnostic and therapeu?
tic aspects〔J〕. J Pediatr Surg，2007，42（11）：1892-1897.
〔17〕DAVEY C，MOORE A M. Necrotizing fasciitis of the
scalp in a newborn〔J〕. Obstet Gynecol，2006，107（2）：
461-463.
〔18〕ULLOA-GUTIERREZ R，RODRÍGUEZ-CALZADA H，
QUESADA L. Is it Acute Omphalitis or Necrotizing Fasci?
itis?：Report of Three Fatal Cases〔J〕. Pediatr Emerg Care，
2005，21（9）：600-602.
〔19〕NAZIR Z. Necrotizing fasciitis in neonates〔J〕. Pediatr
Surg Int，2005，21（8）：641-644.
〔20〕FUSTES-MORALES A，GUTIERREZ-CASTRELLON P，
DURAN- MCKINSTER C，et al. Necrotizing Fasciitis：
Report of 39 Pediatric Cases〔J〕. Arch Dermatol，2002，
138（7）：893-899.
〔21〕DUNLOP R L E，EADIE P. Idiopathic neonatal necrotis?
ing fasciitis caused by community-acquired MSSA encod?
ing Panton Valentine Leukocidin genes〔J〕. J Plast Recon?
str Aesthet Surg，2011，64（11）：1522-1524.
〔22〕ZULOAGA-SALCEDOS,CONTRERAS-RUIZJ, DOMIN?
GUEZ-CHERIT J, et al. An approach to the management
of necrotising fasciitis in neonates〔J〕. Int Wound J, 2005,                                                                                                                                                                                2（2）：178-180.
〔23〕LEE K H，HAHN W H，PARK S S，et al. Necrotizing fasci?
itis in a neonate：the role of keratinocyte allografts〔J〕.
Neonatology，2009，96（1）：19-22.
〔24〕EKINGEN G，ISKEN T，AGIR H. Fournier's gangrene in
childhood：a report of 3 infant patients〔J〕. J Pediat Surg，
2008，43（12）：e39-42.
〔25〕AWE O O，KESIEME E B，KAYODE-ADEDEJI B，et al.
Necrotizing fasciitis of the chest in a neonate in Southern
Nigeria〔J〕. Case Rep Pediatr，2014，2014：818059.
〔26〕LEGBO J N，SHEHU B B. Necrotising fasciitis：experi?
ence with 32 children〔J〕. Ann Trop Paediatr，2005，25
（3）：183-189.
〔27〕BARKER L，PRINGLE K，CUSACK J. Necrotising fasci?
itis with Escherichia coli in a newborn infant after abdomi?
nal surgery〔J〕. Arch Dis Child Fetal Neonatal Ed，2013，
98（5）：F404.
〔28〕DEY S，BHUTIA K L. Neonatal Fournier's gangrene〔J〕.
Arch Iran Med，2010，13（4）：360-362.
〔29〕KREBS V L，KOGA K M，DINIZ E M. Necrotizing fasciitis
in a newborn infant：a case report〔J〕. Rev Hosp Clin Fac
Med Sao Paulo，2001，56（2）：59-62.
〔30〕CHRISTENSEN R D，PYSHER T J，CHRISTENSEN S S.
Case report：perianal necrotizing fasciitis in a near-term
neonate〔J〕. J Perinatol，2007，27（6）：390-391.
〔31〕GANGOPADHYAY A N，PANDEY A，UPADHYAY V D，
etal. Neonatal necrotising fasciitis：Varanasi experience〔J〕.
Int Wound J，2008，5（1）：108-112.
〔32〕MOSAYEBI Z，OMIDIAN A. Fournier's Gangrene in a Ne?
onate With Acute Myeloid Leukemia：A Case Report〔J〕.
Iran J Pediatr，2016，26（3）：e4537.
〔33〕LODHA A，WALES P W. Acute appendicitis with fulmi?
inant necrotizing fasciitis in a neonate〔J〕. J Pediatr Surg，
2003，38（11）：5-6.
〔34〕KOTHARI P R，KULKARNI B. Neonatal necrotizing fasci?
itis〔J〕. Indian Pediatr，2004，41（10）：1070-1071.
〔35〕CHAO H C，KONG M S. Diagnosis of necrotizing fasciitis
in children〔J〕. J Ultrasound Med，1999，18（4）：277-281.
〔36〕BODEMER C，PANHANS A. Staphylococcal necrotizing
fasciitis in the mammary region in childhood：a report of
five cases〔J〕. J Pediatr，1997，131（3）：466-469.
〔37〕RYAN C A，FISCHER J，GAYLE M，et al. Surgical and
postoperative management of two neonates with necrotiz?
ing fasciitis〔J〕. Can J Surg，1993，36（4）：337-341.
〔38〕SAWIN R S，SCHALLER R T，TAPPER D，et al. Early
recognition of neonatal abdominal wall necrotizing fasci?
itis〔J〕. Am J Surg，1994，167（5）：481-484.
〔39〕MONU J U，OKOLO A A. Neonatal necrotizing fasciitis—                                                                                                                                                                         a complication of poor cord hygiene：report of three cas?
es〔J〕. Ann Trop Paediatr，1990，10（3）：299-303.
〔40〕KOSLOSKE A M，BARTOW S A. Debridement of perium?
bilical necrotizing fasciitis：Importance of excision of the
umbilical vessels and urachal remnant〔J〕. J Pediatr Surg，
1991，26（7）：808-810.
〔41〕MONU J U，OKOLO A A. Diffuse abdominal wall celluli?
tis in ascending omphalitis—a lethal association in neonatal
necrotizing fasciitis〔J〕. J Natl Med Assoc，1993，85（6）：
457-459.
〔42〕NUTMAN J，HENIG E，WILUNSKY E，et al. Acute necro?
tising fasciitis due to streptococcal infection in a newborn
infant〔J〕. Arch Dis Child，1979，54（8）：637-639.
〔43〕LALLY K P，ATKINSON J B，WOOLLEY M M，et al. Nec?
rotizing fasciitis：A serious sequela of omphalitis in the
newborn〔J〕. Ann Surg，1984，199（1）：101-103.
〔44〕ÖZKAN H，KUMTEPE S，TURAN A，et al. Perianal necro?
tizing fasciitis in a neonate〔J〕. Indian J Pediatr，1997，64
（1）：116-118.
〔45〕GOLDBERG G N，HANSEN R C，LYNCH P J. Necrotiz?
ing Fasciitis in Infancy：Report of Three Cases and Review
of the Literature〔J〕. Pediatr Dermatol，1984，2（1）：55-
63.
〔46〕WEINBERGER M，HAYNES R E，MORSE T S. Necrotiz?
ing fasciitis in a neonate〔J〕. Am J Dis Child，1972，123
（6）：591-594.
〔47〕董明武，张晓军. 新生儿急性坏死性筋膜炎（附12例报
告）〔J〕. 小儿急救医学，2005，12（2）：147.
〔48〕朱义杰. 新生儿败血症并腹壁坏死性筋膜炎〔J〕. 实用                                                                                                                                                                                 医技杂志，2005，12（23）：3547-3548.
〔49〕彭代勇. 新生儿坏死性筋膜炎1例报告〔J〕. 中国实用
儿科杂志，1998，13（3）：143.
〔50〕茅允成，邓福棠. 新生儿头皮下血肿合并坏死性筋膜炎
及肺脓肿死亡一例报告〔J〕. 西北国防医学杂志，1987，
10（2）：68.
〔51〕蒋南红，谢卫国. 水动力清创系统联合负压封闭引流技
术治疗新生儿广泛性坏死性筋膜炎一例〔J〕. 中华损伤
与修复杂志（电子版），2015，10（6）：548-549.
〔52〕方令仪，丘禹洪，吴文华，等. 新生儿坏死性筋膜炎并开
放性气胸1例〔J〕. 实用儿科杂志，1991，6（2）：102.
〔53〕阙利双. 新生儿败血症合并坏死性筋膜炎一例〔J〕. 新
生儿科杂志，1993，8（5）：208.
〔54〕ZUNDEL S，LEMARÉCHAL A，KAISER P. Diagnosis
and Treatment of Pediatric Necrotizing Fasciitis：A Sys?
tematic Review of the Literature〔J〕. Eur J Pediatr Surg，
2017，27（2）：127-137.
〔55〕LEMARÉCHAL A，ZUNDEL S，SZAVAY P. Pediatric
Necrotizing Fasciitis：Restitutio Ad Integrum after Early
Diagnosis and Aggressive Surgical Treatment〔J〕. Europe?
an J Pediatr Surg Rep，2016，4（1）：34-36.
〔56〕PESCHANSKI N，CHENEVIER-GOBEAUX C，MZABI
L，et al. Prognostic value of PCT in septic emergency pa?
tients〔J〕. Ann Intensive Care，2016，6（1）：47.
〔57〕王盛兴，张敬悌，幸世龙，等. 新生儿睾丸扭转8例诊治
分析〔J〕. 现代泌尿外科杂志，2012，17（5）：501-503.
〔58〕BOMBI?SKI P，WARCHO? S. Ultrasonography of Extra?
vaginal Testicular Torsion in Neonates〔J〕. Pol J Radiol，
2016，81：469-472.

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