EARLY RECOGNITION OF NEONATAL ABDOMINAL-WALL NECROTIZING FASCIITIS

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires e arly diagnosis followed by aggressive surgical debridement. During a 1 0-year period, we treated 7 infants who developed NF. During the same period, 32 infants were admitted with omphalitis that did not progress to NF. The patients with omphalitis and those with NF were compared. Tachycardia, abnormal white blood cell counts, induration, and violace ous skin discoloration were seen exclusively in the NF patients. Polym icrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients. AU omphalitis patients survived, whereas 5 of 7 (71%) NF patients died. Adjuvant hyperbaric oxygen therapy was u sed for 4 infants with NF, 2 of whom survived (50%). NF is a highly mo rbid disease, that can be distinguished from other infant abdominal wa ll infections by the skin changes, white blood cell counts, heart rate , and microbiologic results. Prompt diagnosis of NF improves survival when combined with aggressive surgical debridement.