Outcome analysis of neonatal abscess and necrotizing fasciitis at a tertiary center

Abstract

Background: Skin and soft tissue involvement (SSTI) in neonates usually present as pustulosis, cellulitis, abscesses, necrotizing fasciitis, toxic shock syndrome, and staphylococcal scalded skin syndrome. Early diagnosis and appropriate management are essential for a good outcome. The pattern of neonatal skin and soft tissue infections in fifty neonates presenting at a tertiary referral center is described. Materials and Methods: Data of fifty neonates presenting with skin and soft tissue infection were retrospectively analyzed on the basis of age at presentation, sex, weight, subtype of SSTI, anatomical site, predisposing factors, pus culture, blood culture, management, and outcome. Results: The mean age of presentation was 18.42 days. There were 21 males and 29 females. The mean weight at presentation was 2.83 kg. Forty-one patients had localized abscesses; six had necrotizing fasciitis and three neonates had cellulitis. The thigh was the most common area involved in patients with localized abscesses. Back and anterior abdominal wall were the most commonly involved sites in patients of necrotizing fasciitis. Total leukocyte counts were increased in all patients. Blood culture was positive in two patients with necrotizing fasciitis. Secondary suturing was required in one patient with a large raw area in the region of the axilla. Hospital stay ranged from 3 to 4 days for localized abscesses to 10–45 days for necrotizing fasciitis. Conclusion: There has been an increase in the incidence of neonatal soft tissue infections. Immediate recognition and diagnosis are essential to avoid morbidity and mortality.