Neonatal subcutaneous gangrene is also a type of acute cellulitis, often caused by Staphylococcus aureus. It commonly occurs on the back or lumbosacral region of newborns, areas prone to pressure, and occasionally on the occiput, shoulders, legs, or perineum. It is more prevalent in winter. The skin of newborns is thin and delicate, and local skin areas are more susceptible to pressure and moisture during winter, making it difficult to maintain cleanliness. As a result, bacteria can easily invade through damaged skin, leading to infection. Due to the underdeveloped immune defense mechanisms in newborns (such as immunoglobulin deficiency and reduced neutrophil activity), neonatal subcutaneous gangrene progresses rapidly. If not treated promptly, it can lead to complications like sepsis, bronchitis, and lung abscesses, resulting in a relatively high mortality rate.

bubble_chart Clinical Manifestations

The sick child initially presents with fever, irritability, and refusal to eat, and may even become lethargic. At first, the local skin appears red and slightly swollen with indistinct borders. Upon palpation of the affected area, the tissue feels firm, and the redness blanches under pressure. Within a few hours, the lesion can rapidly expand, with the skin becoming soft and the central area turning dark red. Due to the liquefaction of subcutaneous tissue, the amount of pus formed is minimal, and palpation reveals a sense of hollowness or floating skin beneath. However, when there is a significant amount of pus in the abdominal mass, "fluctuation" may also be detected. Eventually, due to thrombosis in the skin and subcutaneous blood vessels, necrosis of the skin occurs. In some children, multiple blisters appear on the local skin, gradually merging, with the contents turning bloody. The central skin darkens, and an expanding area of necrosis develops.

bubble_chart Treatment Measures

Once the diagnosis is confirmed, multiple incisions (usually about 5-7) should be made for drainage, which can often control further progression of the disease. Each incision is approximately 1 cm in length. If necrosis occurs, the necrotic skin should be promptly excised. Postoperatively, frequent dressing changes are necessary to maintain unobstructed drainage; skin grafting should be performed as early as possible once the wound surface is clean. Systemic administration of antibiotics such as penicillin is required. Additionally, systemic supportive therapy should be strengthened to enhance the child's resistance and promote wound healing.

bubble_chart Differentiation

Pay attention to distinguishing between diaper rash and scleroderma. The skin in diaper rash is red but not swollen, while in scleroderma, the skin is swollen but not red. Neither condition presents with systemic symptoms of infection.