REPORT OF A CASE OF NEONATAL SALICYLATE POISONING DURING THE TREATMENT OF A COLLODION BABY

Yamamura S, Kinoshita Y, Kitamura N, Ogata H, Ohashi A, Kobayashi Y

Department of Pediatrics, Kansai Medical University, Osaka, Japan

 

We report a case of a patient with salicylate poisoning during the topical treatment of a collodion baby. A 2,090 gram male baby was delivered at 38 weeks of gestation to a 27-year-old mother after an uncomplicated pregnancy. He was in appearance of a collodion baby over the entire body surface and was referred us for treatment of respiratory difficulty that was found to be related to limited chest movement from stiffness of skin. He was also severely dehydrated caused by evaporation from epidermis with erosion. He received topical 5% salicylate twice daily over the whole body from the 1st through the 9th day of life with an oral retinoid (etretinoid) at a dose of 1mg/kg/day from the 4th day. But he developed respiratory distress, respiratory alkalosis and metabolic acidosis. On the 8th day retinal and cutaneous bleeding prompted us to conduct coagulation studies: partial thromboplastin time (PTT) of 102 sec, prothorombin time (PT) of less than 10%. Over the next 24 hours, the baby developed renal and heart failure, when arterial PCO2 was 21.5 torr, serum creatinine was 3.1 mg/dl, blood urea nitrogen 72mg/dl, respectively. Blood vitamin A and salicylate concentration on the 7th day of life were 43 IU/dl (normal range 65-276) and 1,190 mg/ml (normal range 150-300), respectively. An assisted ventilation with intubation and peritoneal dialysis was performed. He was discharged with no neurological deficit on the 57th day of life. It is necessary to carefully monitor serum concentrations of salicylate especially in the treatment of a collodion baby because of accompanied easy tendency to dehydration and of higher absorption.

 

 
1956