Managing Peristomal Wounds and Mucus Fistula in a Neonate with a Transforming Powder Dressing

Rosalyn Barnabee and Tammy Jensen-Lichtman share key insights from their poster, “Utilization of Transforming Powder Dressing for Managing Peristomal Wounds and Mucus Fistula in a Neonate After Omphalocele Repair,” presented at SAWC Fall 2023 in Las Vegas, NV.

Transcript

Rosalyn Barnabee, BSN, WON:

So my name is Rosalyn Barnabee. I am a specialized wound ostomy care nurse, and I work for Advent Health in Orlando, Florida.

Tammy Jensen-Lichtman, BSN, CWON:

And I'm Tammy Lichtman, and I am a certified wound and ostomy nurse as well, also working for Advent Health Florida in Orlando.

Barnabee:

Well, in this specific patient's case is a newborn baby boy that had an omphalocele and during the repair process he did have a dehiscence, but he did have an ostomy and a mucus fistula, and the ostomy and a mucus fistula that we needed to isolate to be able to pouch and account for the output that was coming from it. The process of time to isolate the fistula was quite difficult. Being able to create that separation between where the wound was and the ileostomy and the mucus fistula was quite challenging, so we had attempted multiple things that were not holding. The peristomal skin was being affected, so that was creating a lot of pain and discomfort for this baby. So, we needed to find a specific way to be able to get that pouching in place, be able to isolate without really having to isolate in that sense. So that's when the idea to use the transforming powder to protect the wound base and still being able to apply a pouching system where we didn't have to separate the wound from the ostomy. That was the main goal so that we could get the wound to heal but at the same time still be able to protect the peristomal skin from the effluent that was coming out.

Lichtman:

And to also improve pain management. We've had great success with the powder dressing decreasing or alleviating pain. So, it was another component of why we chose this particular product.

Barnabee:

With pediatrics and neonatal, specifically, the fact that their skin has not created that barrier, you have to be careful with the products that you use because things can be absorbed through the skin. You have to be able to use a product that will not interact with other treatments that these neonatals are receiving, but also a product that is biocompatible to eliminate the possibility of the body rejecting whatever treatment we're using. It's that very fine line where you have to find a product that works, but a product that will also protect these babies. Plus the fact that babies cannot express their pain in the same level as an adult. Sadly for them it comes in crying, which crying creates an elevated heart rate. There's so many other things that get affected through that process. We wanted to make sure that whatever we were using will help with that process too. So there's multiple things. It is not just the wound and the comorbidities. It's the wound, the fact that the skin absorbs, the fact that they don't know how to manage pain. They have no other distractions or anything else that you can use with a neonatal to get them to think of something other than the pain. So those factors, I think, you have to really take into account and sometimes you might lose some of them in the effort of trying to get that specific treatment to work.

Lichtman:

And we're also looking for treatments that have longer wear time so we can interfere with that dressing less likely, less often to allow that baby to have opportunities for healing and have safety in a longer wearing dressing.

Barnabee:

Not really. We had seen this product work in adults, first of all, and seeing the time to heal being so quick, which was a surprise the first time we used it in an adult. But when we consistently saw those results in adults, and we had previously tried this product in a micro preemie, so knowing how the micro preemie reacted to it, we were almost 100% sure that this was the way to go and it was going to work.

I think that's still going to be quite challenging because of all the things that come into play when it comes to this type of clinical trials in the pediatric population

Lichtman:

To reproduce for babies and for children. Their wounds are so varied where we don't have a population of a larger number of say, this type of wound. We will have a lot of variations in our wounds. And then when we're looking at ethical, we're looking at safety, we're looking at effective. Those are the things that our practitioners are also looking for. So they're trying to pull on knowledge that they already have. And because the research right now is so scant, then trying to pull in different children, babies to have a volume that would be clinically significant, that's the challenge that we face as the population to do that study.

Barnabee:

I think also the fact that when we are making a decision for ourselves and the risk for ourselves, it's a very different story than when we are making the decision to go on with the treatment for our children, so it's put the parents in a position where it's a little bit more difficult. So sometimes just getting the parents to agree to allow for this type of trials has that challenge in which they're not thinking just for themselves, they're thinking for the child. And that could be a little bit more difficult than to think what we will do for ourselves.