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Treatment of the seriously burned infant
R Sheridan1, J Remensnyder, K Prelack
1Shriners Burns Institute, Boston, MA 02114, USA.
Insights
Infants with large burns have improved survival rates due to advanced management. This study reviews a successful strategy for treating severe burn injuries in infants, emphasizing early intervention and intensive support.
Area of Science:
- Pediatric Surgery
- Burn Management
- Critical Care Medicine
Background:
- Infants with large burns (>30% TBSA) historically face poorer survival outcomes.
- Recent positive experiences prompted a review of management strategies for severe infant burns.
Purpose of the Study:
- To review a 5-year experience with a specific management protocol for infants with large burn injuries.
- To evaluate the efficacy of an organized approach to pediatric burn care.
Main Methods:
- A retrospective review of 12 infants (<12 months) with large burns (average 42% TBSA).
- Management included precise fluid support, early excision (<5 days), biologic wound closure, limited mechanical ventilation pressures, regular central venous catheter replacement, and intensive nutritional support.
- Data collected on demographics, injury characteristics, interventions, complications, and outcomes.
Main Results:
- All 12 infants survived and were discharged home.
- Average age 7.8 months, average burn size 42%.
- Complications included pneumonia, sepsis, and wound infections; 50% required mechanical ventilation.
- Nutritional support was crucial, with both parenteral and enteral routes utilized.
Conclusions:
- A comprehensive strategy combining precise fluid resuscitation, early surgical intervention, avoidance of ventilator-induced lung injury, and intensive nutritional support leads to successful outcomes in infants with large burns.
- This organized approach demonstrates improved survival and recovery for a high-risk pediatric population.
Abstract:
Infants (younger than 12 months) with large (more than 30%) burns are reported to have poorer chances for survival than older children with similar injuries. However, recent experience with such infants has been positive, prompting a 5-year review of management techniques. The injuries were approached in an organized fashion that included precise fluid support, excision, and biologic closure of full-thickness wounds within 5 days, limited exposure to high inflating pressures (more than 40 cm H2O), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route whenever possible. Twelve such infants were treated during the 5-year interval. Their average age was 7.8 months (range, 1 to 12 month[s]), average weight was 8.8 kg (range, 4.3 to 13 kg), and average burn size was 42% (range, 30% to 90%). Inhalation injury was present in two of the children, and one child aspirated hot liquid. Six (50%) of the infants required the support of a mechanical ventilator for an average of 11.6 days (range, 4 to 18 days). Eight children required an average of 5.7 operations (range, 1 to 18 operation[s]), seven required central venous catheters, and five required arterial cannulae. Major infectious complications were seen in four children. Complications included pneumonia (two), catheter sepsis (two), peritonitis from a perforated ulcer (one), and wound sepsis (two). Six children required parenteral nutritional support for an average of 15 days (range, 5 to 36 days), and six children required enteral tube feedings for an average of 23 days (range, 9 to 55 days). Anabolic agents were not used. Discharge weights averaged 8.6 kg (range, 4.9 to 10.5 kg). The average ratio of the children's discharge to admission weight was 101% (range, 73% to 120%). All children survived and were discharged home. We conclude that these difficult injuries can be approached successfully with a strategy that emphasizes precise fluid repletion; early excision and biologic closure of wounds; avoidance of ventilator-induced lung injury; and intensive nutritional support.