Black Eschar on a 4-day-old Preterm Infant

Abstract

A 4-day-old female neonate presented with a black necrotic lesion with circumferential ulceration and erythema located to the left of the umbilicus. ### Prenatal and Birth Histories ### Presentation The infant was admitted to the NICU. An umbilical venous catheter (UVC) was inserted with the use of betadine as the antimicrobial skin preparation and a thin hydrocolloid dressing (DuoDERM®, ConvaTec, Bridgewater, NJ) as a protective skin barrier to secure the UVC. The hydrocolloid dressing was located just left of the umbilicus and placed on intact abdominal skin. The infant was noted to have asymptomatic thrombocytopenia (platelet count 73,000/μL [73×109/L]) and neutropenia (absolute neutrophil count 700/μL [0.70×109/L]), which were attributed to maternal preeclampsia. The infant received 1 dose of granulocyte colony-stimulating factor (G-CSF, 10 μg/kg, subcutaneously) at 2 days of age. Prophylactic antibiotics were not indicated at the time of birth because there were no concerns for infection. The infant underwent extubation to receive nasal noninvasive ventilation within 24 hours of birth. …