[3728229]
Extremely premature infant with multiple necrotic lesions on face, extremities, and trunk that initially appeared 4 days post delivery. Infant was born via vaginal delivery to a g1p1 mom whose pregnancy was complicated by ptl (pre-term labor). She had received steroids and 9 doses of penicillin ptd (prior to delivery). Apgars were 4/6/8. Infant was intubated at birth and given curosurf. At birth was started on amp/gent and fluconazole prophylaxis. Uac/uvc (umbilical arterial catheter/umbilical venous catheter) were placed. Extubated to hfnc dol 1 (high flow nasal cannula day of life 1). Patient developed large pda (patent ductus arteriosus) on day 2 of life that was treated with single dose of indocin. Ampicillin was changed to vancomycin on day 2 of life. He developed grade iii ivh (intraventricular hemorrhage) and perforation of duodenum at day 2 of life. He was re-intubated on day 2 of life. Exploratory lap on day 2 of life. Jejunostomy and mucous fistula. Broviac placed on day 3 of life. On day 4 of life, nursing noted dark lesion on chin. This lesion rapidly enlarged and additional sites subsequently developed on the abdomen, legs and arms. Infection disease (id) physician consulted. Id recommended obtaining fungal cultures of skin lesions and blood and starting amphotericin b and merrem. Fungal cultures positive for rhizopus and bipolaris. At the time these lesions developed the infant had severe acidosis and was on epinephrine and vasopressin. He also had been neutropenic at birth. Staff noted that the initial darkened area occurred on the chin where a skin barrier product was in use. On examining the skin barrier product (opened and unopened) kept at the patient's bedside, an intermittent dark grey/black discoloration was noted along the outer border of the product which raised a concern regarding possible contamination. Product was removed from the bedside and submitted to the lab for testing. When additional unopened product was examined, the same discoloration was noted. As a precaution, a decision was made to remove all product within our system from use until the results of the testing are known. Results expected within ~ 4 weeks. We contacted the manufacturer and notified them of our concern about a possible contaminant. They mentioned that the discoloration may be related to the tool they use to cut their product.
Patient Sequence No: 1, Text Type: D, B5