ADVERTISEMENT
A Clinical Minute: Little Patients, Big Outcomes: The Role of MEDIHONEY® in Pediatric Wound Care
If you treat pediatric wounds, where do you go for information on what to use? The answer is not very clear. Pediatric wound care lacks consensus because most products are developed based on research and trials in adults. Although many of the same wound care principles apply, special consideration must be given to unique characteristics present in pediatrics patients, including fragile and sensitive skin, different comorbidities, and underlying physiological and anatomical skin differences.1,2
In my pediatric wound care practice, I have found concerns voiced by parents and pediatric care teams focus on safety and long-term outcomes of products applied to wounds on infants and children. Parents feel a lack of control, but respond positively to natural and gentle dressings that are effective and easy for them to use, especially during dressing changes.
In both pediatric and adult patients, wound management goals include promoting debridement, achieving moisture balance, and supporting wound healing. MEDIHONEY® aids in achieving these goals through its two key mechanisms of action: 1) a low pH (3.2–4.5) to help modulate alkaline pH common in chronic wounds3-5 and 2) high osmolarity to increase wound bed fluid and promote autolytic removal of nonviable tissue.6-8 In addition, MEDIHONEY® is available in a variety of formulations, which provides versatility to treat a range of pediatric wounds in patients of all ages.
The following cases illustrate the use of MEDIHONEY® products to aid in the autolytic debridement of pediatric wounds. 
Case 1. A 7-day-old, 33-week-old premature baby had severe IV infiltrate during infusion with total parenteral nutrition and intralipid therapy (TPN/IL) on the right lateral malleolus (see Figure 1). We applied MEDIHONEY® gel and MEDIHONEY® calcium alginate daily to the wound to aid in autolytic debridement. We cross-hatched the eschar to allow the honey to penetrate deeper into the wound bed. By day 10, MEDIHONEY® facilitated softening of the eschar to allow for easy separation and removal at the bedside (see Figure 2). MEDIHONEY® treatment was continued and by day 17, the entire wound bed was clean, healthy, and free of all debris (see Figure 3). The wound resolved by day 54 with no contractures and preservation of the full range of motion.
Case 2. A 17-year-old young man with hypoplastic left heart syndrome, multiple cardiac surgeries, protein losing enteropathy, and chronic steroid use presented with a traumatic wound on his left lower leg following a jet ski accident. At the time of presentation, the wound was covered in slough and eschar and had significant drainage (see Figure 4), and the patient was in considerable pain with limited mobility. We applied MEDIHONEY® gel and MEDIHONEY® calcium alginate daily to the wound to aid in autolytic debridement of the nonviable tissue. Progress was evident as early as day 3 (see Figure 5), and by day 15 the wound bed was clean and free of all nonviable tissue (see Figure 6). After 15 days of treatment, pain was significantly reduced and the patient no longer required the use of a wheelchair. Advanced wound dressings were utilized thereafter to successfully obtain full closure and granulation of the wound.
Conclusion
These cases illustrate how MEDIHONEY® rapidly provides safe, gentle, effective debridement in pediatric wounds. In these cases, the combination of MEDIHONEY® gel and MEDIHONEY® calcium alginate helped achieve direct contact with the wound bed, leading to the benefits of immediate and prolonged activity of the honey. In the past 2 years, I have used MEDIHONEY® on more than 150 pediatric patients with excellent outcomes. These positive results have helped me address the safety and long-term outcome concerns of parents and pediatric care teams. Pediatric patients of all ages can benefit from effective wound care practices, because little patients also deserve big outcomes.
For more cases demonstrating outcomes of MEDIHONEY® in pediatric wound care, visit the MEDIHONEY Power Webinar series at www.dermasciences.com/elearning-portal for a 30-minute case review by Dr. Rene Amaya.
A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.
1. McCord SS, Levly ML. Practical guide to pediatric wound care. Sem Plas Surg. 2006;20(3):192–199.
2. Baharestani MM. An overview of neonatal and pediatric wound care knowledge and considerations. Ostomy Wound Manage. 2007;53(6):34–55.
3. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014;23(2):53–57.
4. U.S. Food and Drug Administration. Medical devices: January 2011 510(k) clearances. Available at: www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/510kclearances/ucm246213.htm. Accessed August 6, 2014.
5. Gethin G. Influence of Manuka honey on surface pH, MMP-2, MMP-9 and wound size of chronic wounds. Presented at the European Wound Management Association Conference, Lisbon, Portugal. May 2008.
6. Acton C, Dunwoody G. The use of medical grade honey in clinical practice. Br J Nurs. 2008;17(20 suppl):S38–S44.
7. Chaiken N. Pressure ulceration and the use of active Leptospermum honey for debridement and healing. Ostomy Wound Manage. 2010;56(5):12–14.
8. Gethin G, Cowman S. Manuka honey versus hydrogel — a prospective, open-label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2008;18(3):466–474.
