Evaluation of Safety and Efficacy of a Concentrated Surfactant Gel in Management of Complex Neonatal and Pediatric Wounds

Background: Neonatal and pediatric wounds are unique in percutaneous absorption, systemic toxicity, difficult and painful application, and removal limit products utilized. Non-ionic poloxamer 188-based concentrated surfactant gel (CSG) is built with hydrophilic and hydrophobic chains, forming sphere-like micelles, converging into a micelle gel matrix, that is non-cytotoxic and biocompatible. The high water solubility of CSG leads to effective exudate/debris solubilization and removal, while protecting the underlying healthy and granulating tissue (especially due to thickening effect of warm temperature on the gel).

Objective: The purpose of this case series is to demonstrate safety and efficacy of concentrated surfactant gel in various neonatal and pediatric wounds.

Methods: Seven pediatric cases are presented, representing a larger cohort, including neonate with aplasia cutis congenita lesions on the scalp, neonatal peristomal skin burn, significant peripheral intravenous extravasation wound, dehisced abdominal wound, and neonatal hyperkeratosis where CSG facilitated a combination of autolytic and mechanical debridement, as well as a 3-month-old with occipital pressure injury, and a 3-year-old with peristomal dermatitis and erosions.

Results/Conclusions: The CSG led to complete epithelization of aplasia cutis congenita lesions in a short time (2–3 weeks), faster than previous products we utilized. Gastrostomy complications, including burns, dermatitis, erosions, and pressure injuries, completely healed within 3–7 days. CSG is an excellent emulsifier. It softened hyperkeratotic layer, exudate, and thicker slough effectively, while minimizing wiping at dressing changes and preserving healthy granulation tissue. Normal saline or water were effective in gentle exudate removal. It was easy to apply in general and in difficult-to-apply places. There were no adverse effects related to CGS usage. All patients achieved desired outcomes, in a timely manner. CGS should be considered in a variety of pediatric cutaneous conditions and injuries.