Biobrane ® in bairns with burns and bugs?

Abstract

1. Summary The physiological and immunological impact of burns in children is well described. Biobrane 1 is a commonly used product in the treatment of superficial burns in children and has many attractive properties, warranting its use. Unfortunately, bacterial super-infections and serious sepsis due to Staphylococcus aureus and group A beta haemolytic are ever increasing complications in the patients under the age of five who have been exposed to Varicella Zoster Viruses. Biobrane 1 , despite its healing properties, is a foreign substance and we ask the question whether recent or current chickenpox is a relative contraindication to its use. Burns, due to their very nature, pose a challenging problem with regard to bacterial super-infection, especially in very young children. In recent years, the acute management of scalds and superficial burns in young patients (bairns: Scottish term for children) has changed. Current practice involves thorough cleansing of the wound, usually under general anaesthesia, and application of Biobrane 1 (Bertek Pharmaceuticals Inc., Morgantown, West Virginia, USA). It is marketed on the premise that the highly purified peptides from porcine dermal collagen, bonded to a nylon and silicone semipermeable membrane, minimises bacterial proliferation by minimising dead space. Previously, partial thickness burns in children involved painful daily bathing, washing and cleansing of the burn wound followed by topical application of antimicrobial creams [1]. Biobrane 1 diminishes the need for daily wound dressing which increases exposure of the wound, has an analgesic effect and, therefore, minimises the use of painkillers while providing a suitable environment for re-epithelialisation. One randomised trial showed that there were also fewer infections when compared with 1% silver sulphadiazine [1]. Since changing our protocol for the management of paediatric burns, two cases have come to light which we feel warrant further investigation concerning its use in children with burns who also have a current or recent Varicella Zoster Virus infection or who may have been exposed to it. Bacterial super-infections are one of the most common complications following Varicella Zoster Virus infection. Although other complications such as Reyes syndrome, encephalitis, pneumonia, hepatitis, glomerulonephritis, cerebellar ataxia, arthritis and purpura fulminans are also recognised, skin and soft tissue infection are still the most frequent manifestations of the virus within healthy children [2,3]. These complicated infections are more common in children below the age of five and are largely due to S. aureus (SA) and group A beta haemolytic streptococcus