Necrotizing fasciitis following rapidly deteriorating neonatal omphalitis with good initial presentation
Jin Sato,
Nobuyuki Yotani,
Kensuke Shoji,
Teizaburo Mori,
Akihiro Fujino,
Makoto Hikosaka,
Mitsuru Kubota,
Akira Ishiguro
Affiliations
Jin Sato
National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Nobuyuki Yotani
NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; NCCHD, Division of Palliative Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; Correspondence to: Division of Palliative Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
Kensuke Shoji
NCCHD, Division of Infectious Diseases, Department of Medical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Teizaburo Mori
NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Akihiro Fujino
NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Makoto Hikosaka
NCCHD, Division of Plastic Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Mitsuru Kubota
National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Akira Ishiguro
NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
Neonatal omphalitis is a postpartum infection of periumbilical superficial soft tissues that usually has a good prognosis in developed countries. In rare cases, it could progress to periumbilical necrotizing fasciitis (NF), which is an infection of the deep soft tissues, including muscle fascia, and has a high mortality rate. However, the signs and timing of developing NF secondary to omphalitis are unclear. We encountered a neonatal case of NF following omphalitis. In the initial days of the clinical course, general symptoms and condition of the patient were good, and abdominal physical findings were mild; however, the patient rapidly developed NF. The patient was successfully treated by emergent surgical debridement, broad-spectrum antibiotics, and intensive care. To determine the area of blood perfusion, we intravenously injected indocyanine green by intraoperative angiography, and then extensively removed necrotic and hypoperfused tissues. In neonatal omphalitis, the deterioration can suddenly occur despite good initial conditions; intensive monitoring should be required during the first few days of the clinical course.
