Cleansing neonatal and pediatric wounds: efficacy and safety of hypochlorous acid

Safe wound debridement is essential in pediatric practice. Neonatal skin, especially preterm skin, is underdeveloped and at risk for injury, enhanced systemic absorption of topical products and potential toxicity. Historically, water or normal saline are used in pediatric cleansing. Scientifically neither have been proved as optimal cleansers; practically, practitioners use various additives to enhance skin and wound cleansing. Consideration for a debriding or cleansing antimicrobial agent include acidic to neutral pH, as preservation of acid mantle is paramount, naturally produced or synthetic non-cytotoxic components, fast-acting action and superior efficacy.
This is an observational series describing use of hypochlorous acid (HA) in pediatric patients with various wounds. Wounds included extravasation injuries, poorly healing giant omphalocele, dehisced surgical abdominal wound and pressure injury. All wound beds required gentle debridement as slough was present. Patients ranged from 5 days old, ex 26-week premature baby, 4-month-old, 8-year-old with multiple co-morbidities to a 16-year-old.  Various forms of debridement were performed, including autolytic, enzymatic and mechanical. Wound cleansing was done in all patients prior to dressing changes and pre/ post debridement with hypochlorous acid soak and HA-saturated microfilament debrider. One of the wounds required NPWT due to significant depth; it was prepared with hypochlorous acid due to slough presence and minimum granulation tissue. Patient was discharged home with portable single use NPWT device. Wound bed improved on day 7. NPWT was discontinued. Patient’s caregivers were educated on the application of HA soak followed by medical grade honey gel and secondary dressing every 2-3 days.
HA was effective in enhancing wound bed preparation, while painless and non-irritating in all patients. HA can be used as a sole debriding/cleansing agent or in combination with other dressings. Available clinical experience in neonatal population points to safe and efficacious outcomes.

Trademarked Items (if applicable): Vashe® wound solution, URGO Medical, Fort Worth, TX

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