The use of Acticoat™ in neonatal burns
Introduction
Neonatology in recent years has advanced so that babies as young as 23 weeks gestation are surviving ex-utero. However, with this extreme prematurity comes a unique set of challenges. In a premature neonate, minimal handling can cause hypoxaemia, and over stimulation can cause severe cardiorespiratory decompensation [9]. With immature and thin epidermis prone to injury, thermoregulation is difficult, and the neonate is prone to nosocomial infections [11]. This paper looks at a series of eight extremely premature neonates who sustained burn injuries and other skin injuries from various causes, successfully treated with the nanocrystalline silver dressing Acticoat™, without requiring scar management. Acticoat™ is a gauze dressing of silver coated high density polyethylene mesh with a polyester/rayon core. The silver coating is formed by a physical vapor deposition process called magnetron sputtering. The coating film produced is abrasion resistant, non-adherent and flexible, with 0.2–0.3 mg silver/mg polyethylene [14].
Section snippets
Method
At the Royal Brisbane and Women's Hospital's Neonatal Intensive Care Unit, Brisbane, Australia, between 2002 and 2004, eight premature neonates who sustained primary burn injuries, were managed with Acticoat™ or Acticoat 7™, changed every 3–7 days. Low birth-weight (LBW) was defined as weight less than 2500 g, very low birth-weight (VLBW) as less than 1500 g, and extremely low birth weight as less than 1000 g [10]. A preterm neonate is defined as being less than 37 weeks of gestational age.
Results
The mean gestation at birth was 24.5/40 (range: 23–27.5/40), with a mean birth weight 769 g (range: 578–1078 g), putting these neonates into extremely low to very low birth weight category. Median age at the time of burn was 5 days (range: 1–44 days). Total body surface area burned ranged from 1 to 30%. All neonates were treated with Acticoat dressing, changed every 3–7 days. Out of eight neonates, one suffered chemical burns from alcoholic chlorhexidine (0.5% chlorhexidine plus 70% alcohol) (
Discussion
An ideal dressing used for burn injury should provide antimicrobial cover to minimise the growth of the patient's endogenous bacteria and prevent colonization by nosocomial organisms. It should promote healing and minimize discomfort associated with dressing care, whilst being cost-effective to the patient and the health care system [14]. Such desired attributes of a dressing are no more pertinent than in the care of premature neonates.
In this series all neonates were of less than 27 weeks of
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