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.