Surgical and postoperative management of two neonates with necrotizing fasciitis

Two neonates who presented with necrotizing fasciitis (NF) secondary to omphalitis were treated by radical excision of the anterior abdominal wall. Postoperatively, renal failure in both children was managed by continuous arteriovenous hemofiltration (CAVH). One child survived; the other died of sepsis. Serum lactate levels, which were 10 to 15 times the normal levels in both infants postoperatively, decreased rapidly in the survivor, but never approached normal levels in the infant who died. Although the best prospect for survival in neonatal NF remains prompt, radical, surgical excision and is associated with a low threshold for repeat débridement, modern supportive measures (including CAVH) may enhance survival.