Abstract 1585

Necrotizing fasciitis (NF) is a rare bacterial infection of the soft tissue in childhood with a fulminant course and a high mortality rate. We have treated three newborns in whom NF developed without a known causative factor or portal of entry back for bacteria. Laboratory data revealed leukocytosis with left shift and CRP elevation. All of these infections started on the back and extended to the flanks in one case. Cultures of the involved areas grew Staphylococcus aureus All patients survived after broad-spectrum spectrum antibiotics, faciotomy and extensive surgical debridement. These three patients and sixty-five newborn infants reported in literature were reviewed. There was no sex predominance. Only three cases were premature. The associations of necrotizing fasciitis were omphalitis (47), mammitis (5), balanitis (4), postoperative complication (2), septisemia (2), fetal scalp monitoring (2), necrotizing enterocolitis (1), bullous impetigo (1), immunodeficiency (1), and unknown causative factor in our three cases. In most of the cases, the initial skin change was a warm, erythematous, indurated and tender area without distinct margins. The overlying skin might later develop a dusky blue gray color, bullae or gangrene. Progression of the inflammation was alarmingly rapid. Fever, tachycardia, abnormal leukocyte counts and elevated acute phase reactant levels were common but not uniformly present. Hypocalcemia was uncommon. Although clinical manifestation and imaging study including ultrasonography and CT scan raised the high index of suspicion, the definite diagnosis were usually made at surgery by demonstration of a lack of resistance of normally adherent fascia to surgeon's fingers or blunt probe dissection. It was usually a polymicrobial infection in secondary necrotizing fasciitis and the abdominal wall was the most common site of initial involvement, while primary necrotizing fasciitis was a monomicrobial infection caused by Staphylococcus aureus and occurred commonly in the lumbar area. Overall mortality rates are as high as 57% (39/68). Most of them died of septic shock, disseminated intravascular coagulation, and/or multiple-organ failure. Prompt diagnosis, intensive supportive care, adequate antibiotics and aggressive surgical therapy are essential for the management of neonatal necrotizing fasciitis.