Periumbilical necrotizing fasciitis in the newborn

 Periumbilical necrotizing fasciitis in the newborn

Neonatal necrotizing fasciitis is a rare complication of omphalitis.

Necrotizing fasciitis starts initially as periumbilical cellulitis and rapidly spreads to the subcutaneous tissues, with the overlying skin appearing edematous with purplish blue discoloration.

Necrotizing fasciitis may also present with bullae, crepitus and peau d’orange appearance.

Necrotizing fasciitis should be recognized early and treated aggressively by debridement, broad-spectrum antibiotics, and supportive care.

In addition to debridement of the involved abdominal wall, it is important to resect the umbilical vein, both umbilical arteries, and any urachal remnant that is present, as these may be involved in the necrotizing infection (even if they look normal).

Reported mortality rates are as high as 60 to 85 percent.

References:

1. Cilley R. Disorders of the umbilicus. In: Pediatric Surgery, Grosfeld J, O'Neill J, Coran A, Fonkalsrud E (Eds), Mosby Inc., Philadelphia 2006.
2. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am 2004; 51:819.

 

Adolescent psychosocial history

Adolescent psychosocial history

A full adolescent psychosocial history is useful to engage the young person, to assess the level of risk, as well as identifying protective or resilient factors and provide information that will aid the formulation of effective interventions. The HEADS acronym may be helpful in this regard, although questions must always be tailored to stage of development and the right of the young person to not answer should be respected.

 

Refeeding Syndrome

Refeeding syndrome occurs in response to reintroduction of nutrition (whether enterally or parenterally) in the malnourished patient.

Rapid electrolyte and fluid Intracellular shifts in response to the surge of insulin brought on by the presence of nutrients which can lead to numerous medical complications and may progress to life-threatening outcomes, including Coma heart failure, and sudden death.

The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.

Pathogenesis (Howdoes refeeding syndrome develop?) 

Clinical Signs and Symptoms of Refeeding Syndrome

Patient populations at risk for refeeding syndrome  

Prevention and management of refeeding syndrome