TITLE:
Neonatal Necrotizing Fasciitis after Circumcision: A Case Report and Review of Literature
AUTHORS:
Ada L. Rivera Cruz, Zasha F. Vázquez Colón, Hector Quintero, Cesar Carballo Cuello, Victor N. Ortiz Justiniano
KEYWORDS:
Cellulitis, Abscess, Subcutaneous, Erythema, Penrose, Debridement, Granulation
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.6 No.1,
March
8,
2016
ABSTRACT: Background: Necrotizing fasciitis is a soft tissue infection that occurs predominantly in adults. Although rare, only 70 cases have been reported in neonates. This entity, most commonly caused by multiple organisms is often fatal, with 50% mortality. The combination of a low incidence and high mortality in this subgroup strengthens the need for early diagnosis, prompt recognition and immediate surgical treatment in order to improve survival. Aim: The aim of this case report is to bring awareness of a clinical condition that relies mostly on physical examination and where early diagnosis and immediate surgical treatment are needed in order to improve survival. Case presentation: We report the case of an 8-day-old boy presenting neonatal necrotizing fasciitis after circumcision. Patient presented with lower back erythema and areas of fluctuation. He was started on antibiotic therapy and 24 hours after admission, he was taken to the operating room for multiple fasciotomies, debridement and cleansing of affected areas. Findings were consistent with necrotizing fasciitis. After surgical intervention, local care was given until complete healing was achieved, approximately one month after admission. Conclusion: The surgeon must be attentive for the possible occurrence of this lethal infection that may develop post operatively after clean or clean-contaminated procedures. Preparation for treating these patients immediately with adequate fluid resuscitation, appropriate antibiotics and aggressive surgical debridement of non-viable tissue will provide the maximal potential for recovery. These prompt measures will offer the best chance for survival and eventually decrease the 50% mortality rate associated to the neonatal population.