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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 28  |  Issue : 1  |  Page : 101-103

Scald burns in a 7-h old neonate: A consequence of traditional hot water bath


Department of Paediatrics, Federal Medical Centre, Katsina, Nigeria

Date of Submission15-Apr-2020
Date of Decision19-Oct-2020
Date of Acceptance22-Oct-2020
Date of Web Publication21-May-2021

Correspondence Address:
Dr. Abubakar Sani Lugga
Department of Paediatrics, Federal Medical Centre, Katsina
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_7_20

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  Abstract 


Burn injuries are rare in the neonatal period. Most of the cases reported in the literature are iatrogenic. We report the case of a 7-h old female neonate who presented with domestic accidental scald burns involving 18% of the total body surface area. She sustained the burns during a traditional bath with hot water. She was resuscitated with intravenous fluid, and urine output was monitored. She was nursed under a radiant heater and was given analgesics and tetanus antitoxin. She had wound sepsis from Pseudomonas species which was successfully treated with intravenous antibiotic (ceftazidime). She also had anemia which was corrected with packed red blood cell transfusion. Wound dressing was done with antibiotic-impregnated gauze until the wounds were satisfactorily healed. She was discharged from the hospital on the 29th-day postburn.

Keywords: Domestic burn, harmful traditional practices, neonatal burn, scald burn


How to cite this article:
Lugga AS, Sulaiman BM, Ibrahim LM, Abiodun YS. Scald burns in a 7-h old neonate: A consequence of traditional hot water bath. Indian J Burns 2020;28:101-3

How to cite this URL:
Lugga AS, Sulaiman BM, Ibrahim LM, Abiodun YS. Scald burns in a 7-h old neonate: A consequence of traditional hot water bath. Indian J Burns [serial online] 2020 [cited 2021 Jun 19];28:101-3. Available from: https://www.ijburns.com/text.asp?2020/28/1/101/316582




  Introduction Top


It is a traditional practice in Northern Nigeria to bath both the mother and baby with hot water twice in a day throughout the puerperium.[1] This has been associated with several complications one of which is scald burn in the mother or the baby. In our report, the baby was the victim.

Pediatric burns are associated with higher morbidity and mortality than in adults and therefore, require specialized burn care and attention.[2] Burn injuries are more devastating in the neonatal period and are associated with more long-term complications.[2] Neonates are the rarest victims of burns with only a few cases of neonatal burns described in the literature.[3] Most of these cases were iatrogenic, and only a handful of domestic neonatal burns has been reported.[3] We report the case of a full-term neonate who sustained deep partial thickness scald burns at about 6 h of life.


  Case Report Top


A 7-h old female neonate was rushed into the special care baby unit of the hospital about an hour after sustaining scald burns from hot water. While bathing the baby with hot water, the mother noticed redness of the baby's lower limbs and buttocks, accompanied by an inconsolable cry. A few minutes later, she noticed blisters on the child's body. Tap water was poured on the baby's body before rushing to the hospital. At presentation, the child was crying inconsolably, with deep partial-thickness burns involving both glutei, medial and posterior aspects of both thighs and legs, and the dorsal surfaces of both feet [Figure 1] and [Figure 2]. The total body surface area (TBSA) involved was estimated to be 18% using the Lund and Browder chart. Vital signs were normal. Intravenous fluid resuscitation was commenced with half-strength normal saline with 5% glucose, according to the Parkland formula at 4 ml/kg/% TBSA burnt plus daily maintenance requirement. A Foley's urinary catheter was passed and fluid therapy was adjusted to maintain an adequate urine output of 1–2 ml/kg/h. Breastfeeding was commenced 24 h postburns, and intravenous fluid was stopped on the third day of admission. The baby was kept warm under a radiant heater, and broad-spectrum antibiotic (cefuroxime) was commenced. Analgesic (intravenous paracetamol) and Tetanus antitoxin (ATS) were administered. Wound dressing was commenced on admission using silver sulphadiazine cream and antibiotic (framycetin sulphate) impregnated gauze. Packed cell volume on admission was 45% and fell progressively to 28% on the 14th-day postburn, warranting packed red blood cell transfusion. Serum electrolytes, urea, and creatinine were monitored and remained normal throughout the admission period. The baby developed fever with an axillary temperature of 39.4°C on the 4th day of admission and greenish pus was noticed exuding from the burnt site on the right leg. Full septic screen was carried out on the same day, and antibiotic was changed to ceftazidime. There was absolute neutrophilia with a left shift of neutrophils. Pseudomonas species sensitive to ceftazidime was cultured from wound swab. Blood and urine cultures had no microbial growth. Ceftazidime was given for 10 days even though the fever resolved within 48 h of its commencement. Wound dressing on all sites was done daily for 14 days, and subsequently, on alternate days until healing was satisfactory on most sites except the right leg [Figure 3]. The baby was discharged home on the 29th day. Dressing of the burn wound on the right leg with normal saline irrigation was continued on alternate days as an outpatient. Complete healing was noticed by the 38th-day postburn.
Figure 1: Posterior view of the neonate on the 3rd day of burn injury

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Figure 2: Anterior view of the neonate on the 3rd day of burn injury

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Figure 3: The neonate on the 29th day of burn injury

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  Discussions Top


The most common mechanism of domestic burn injury in neonates is accidental scald burn from hot water during bathing or other domestic use.[4] Other mechanisms include contact burns from room heaters and flame burns from leaked cooking gas or candles.[4]

Burn injuries in the neonatal period are associated with greater morbidity and mortality than in older age groups and pose greater management challenges.[3] Neonates with burns are more prone to dehydration than adults because of their relatively larger surface area to mass ratio and hence larger evaporative fluid loss, as well as their higher blood volume relative to body mass.[2] Fluid resuscitation is, thus, the most important intervention required in the first 24 h.[5] The fluid used for resuscitation should contain glucose to meet both fluid and calories requirement of the neonate because the acute phase of burn is a hyper-catabolic state.[5] Fluids of choice include 5% dextrose in 0.45% saline and Ringer's lactate with 5% glucose.[3] Albumin and fresh-frozen plasma can also be used, especially in neonates who have hypoalbuminemia. The Parkland formula gives a guide on the amount of fluid required for resuscitation in the first 24 h of burn which is 4 ml/kg/%TBSA burnt plus daily maintenance requirement.[4] Although Parkland formula is widely accepted, its use has been associated with “fluid creep” which is the accumulation of fluid in the extracellular compartment and third spaces.[6] The urine output must, therefore, be constantly monitored and readjustments of fluid infusion made to maintain a urine output of 1–2 ml/kg/h throughout the resuscitation period.[4]

The thinness of the dermal layer of the neonate's skin, less subcutaneous fat, and higher fluid loss render the neonate with burn injury more prone to hypothermia.[2] Measures should be taken to prevent hypothermia by nursing the patient in a thermoneutral environment and avoiding prolonged exposure during dressing.[3],[7] The index patient was kept under a radiant heater with no record of subnormal temperature throughout the period of hospital stay.

The neonate with burn is also at a greater risk of infection due to the immaturity of their immune system and the fragility of their skin.[2] Pseudomonas aeruginosa and Staphylococcus aureus Scientific Name Search  are the two most common causes of infection in neonates with burns.[5] Pseudomonas species was isolated from the infected burn wounds of the index patient and was successfully treated with intravenous ceftazidime. A possible source of this infection is the contamination of the wounds during dressing. Routine prophylactic use of systemic antibiotics does not reduce the risk of sepsis in patients with burns but topical antiseptic material reduces the local growth of bacteria.[7] Wounds can be cleansed with warmed normal saline followed by the application of topical antibiotics (silver sulphadiazine, fusidic acid, or honey tulles) and aseptic dressing.[4]

Pain control in this baby was with paracetamol which has been proven to be effective and safe in neonates.[8] Opioids have also been used for analgesia in neonates with burns.[3],[5],[8] The index baby had anemia warranting packed red blood cell transfusion on the 14th-day postburn. The factors that contribute to anemia in burn patients include blood loss directly from damaged capillaries and during wound dressing, depressed erythropoiesis, red blood cell sequestration, and direct erythrocyte damage.[9] Anemia prevents burn wound healing and results in the failure of skin grafts.[9]

This baby's wounds, although deep at some areas, healed completely without the need for skin grafting. While excision and grafting remain the gold standard of surgical care of deep burns, there are certain challenges among neonates in particular which include limited area of available healthy skin for autograft and potential bleeding and scarring of donor sites.[2],[4] Tetanus antitoxin (ATS) was administered to this baby because burn wounds are tetanus-prone wounds, even though no recommendation exists currently regarding tetanus immunoglobulin/antitoxin (ATS) administration for neonatal burns.[3]


  Conclusion Top


Traditional practices have been found to dominate newborn care in developing countries and contribute significantly to morbidity and mortality in the newborn.[1] Scald burns from hot water bath is an important but neglected complication of bathing the baby, especially in the developing countries.[4] The World Health Organization recommends that bathing should be delayed until 24 h of birth and if this is not possible due to cultural reasons, bathing should be delayed for at least 6 h.[10] The water used for bathing the newborn should be warm (37.0°C–38.0°C), neither too cold to cause hypothermia, nor too hot to inflict burns.[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rabiu A, Garba I, Abubakar IS. Ritual hot bath (wankan jego) in Kano : Are they still practising? What are the implications ? Sahel Med J 2016;19:215-9.  Back to cited text no. 1
  [Full text]  
2.
Mathias E, Murthy M S. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. Medicines (Basel) 2017;4:91. doi:10.3390/medicines4040091.  Back to cited text no. 2
    
3.
Al-Ahdab M, Al-Omawi M. Deep partial scald burn in a neonate: a case report of the first documented domestic neonatal burn. J Burn Care Res 2011;32:e1-6.  Back to cited text no. 3
    
4.
Saaiq M, Ahmad S, Zaib S. Neonatal burn injuries: an agony for the newborn as well as the burn care team. Ann Burns Fire Disasters 2013;26:175-81.  Back to cited text no. 4
    
5.
Pramod G, Ridhima S. Basic of fluid considerations in neonates with burn– Current perspectives. J Anesthe Advan Res 2018;1:1-5.  Back to cited text no. 5
    
6.
Saffle JR. The phenomenon of “ fluid creep “ in acute burn resuscitation. J Burn Care Res 2007;28:382-95.  Back to cited text no. 6
    
7.
Yastı AÇ, Şenel E, Saydam M, Ázok G, Çoruh A, Yorgancı K. Guideline and treatment algorithm for burn injuries. Ulus Travma Acil Cerrahi Derg 2015;21:79-89.  Back to cited text no. 7
    
8.
Haidon JL, Cunliffe M. Analgesia for neonates. Contin Educ Anaesthesia, Crit Care Pain 2010;10:123-7.  Back to cited text no. 8
    
9.
Posluszny JA Jr, Gamelli RL. Anemia of thermal injury: combined acute blood loss anemia and anemia of critical illness. J Burn Care Res 2010;31:229-42.  Back to cited text no. 9
    
10.
World Health Organization. WHO Recommendations on Newborn Health: Guidelines Approved by the WHO Guidelines Review Committee. Geneva; World Health Organization: 2017.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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