Dehydrated human amnion/chorion membrane for the treatment of severe skin and tissue loss in an preterm infant: a case report.

Abstract

Extreme prematurity complicated with severe congenital cutaneous candidiasis (CCC) is rare and clinically challenging. We present the case of a 615g dizygotic twin delivered at 24 weeks gestation with congenital candidiasis, who developed severe skin and tissue loss, successfully treated with dehydrated human amnion/chorion membrane (dHACM). The infant had a complicated medical course, including treatment for patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), and neonatal abstinence syndrome (NAS). In the operating room after debridement, dHACM was placed over all abdominal and back areas of skin loss and covered with a non-occlusive, non-adherent silver dressing. This dressing regimen was chosen in an effort to provide not only topical antimicrobial coverage, but also to maintain a non-shear, moist wound healing environment, which was so important in the dry incubator environment of the neonatal intensive care centre. Over the next four weeks, the baby was medically managed, and the wounds healed on their own with only weekly bedside dressing changes. This case report provides the first example of successful complex management of extensive life-threatening wounds in a premature infant using dHACM.