Silver Sulfadiazine and Recombinant Human Epidermal Growth Factor Treatment for Neonatal Extravasation

Background: Neonates are at high risk of intravenous extravasation, which can cause severe tissue necrosis. However, few studies have combined silver sulfadiazine (SSD) with recombinant human epidermal growth factor (rh-EGF), which has limited application in neonatal patients, to treat extravasation. This report describes the case of a female neonate treated with SSD and rh-EGF for a skin injury caused by epinephrine extravasation. Clinical Findings: The patient (gestational age: 33 + 5 weeks) experienced extravasation during epinephrine hydrochloride infusion on the first day of hospitalization in the neonatal intensive care unit (NICU). Primary Diagnosis: Extravasation was diagnosed 6 hours following initiation of epinephrine hydrochloride infusion, which led to specific signs, including erythema, swelling, and pain. Interventions: The patient suffered an extravasation injury in her right lower limb. Sterile puncture points were made from the edge of the leak toward the puncture center. Phentolamine was administered at the puncture site. SSD and rh-EGF were applied to the injured area and covered with Vaseline gauze. Outcomes: After treatment, the extravasation injury in the right lower limb resolved without any debridement or noticeable signs of infection. The black and purple skin discoloration decreased gradually, achieving normalization 13 days post-injury. The patient recovered completely with no scarring and was subsequently discharged. Practice Recommendations: Patients receiving infusions with high extravasation risk should be continuously and carefully evaluated for signs of dislocation, leakage swelling, or extravasation to quickly identify and prevent further injury. Combining SSD and rh-EGF may be an alternative treatment for advanced extravasation lesions in the NICU.