Rare Presentation of Neonatal Necrotizing Fasciitis: Case Series and Review of Literature

unit (NICU) with a history of fever, irritability, and a purulent bulla over the occiput for 2 days.He exhibited swelling, erythema, and deep induration over the scalp skin, with the presence of granulation tissue and a clear line of demarcation covering a wide region from the temporoparietal scalp to the nape of the neck.The surrounding skin showed warmth and a light purplish discoloration (Fig. 1A).The baby was tachypneic on presentation with tachycardia and mottling.Blood was drawn for a septic screen, and broad-spectrum intravenous antibiotics were commenced, namely, injection of meropenem, linezolid, and metronidazole IntroductIonNecrotizing soft tissue infections are rapidly progressive, fatal, polymicrobial infections with a fulminating course, infecting the epidermis, dermis, subcutaneous tissues, and superficial and deep fascia, and may extend to the muscular planes. 1 The disease may present as fasciitis, myositis, or cellulitis, of which necrotizing fasciitis is the most common form, with the rest being close differentials to diagnosis.The infection is typically known to traverse the fascial planes, which are poor in blood supply, sparing the overlying connective tissues, thus delaying the diagnosis and prolonging the time to scrutinize and initiate prompt treatment.The global prevalence is about 0.4 cases in every 100,000 people, and it is a disease of the adult immunocompromised population. 2 However, it is rarer in children, particularly in infants, with an incidence of 0.08 to 1 case per 100,000 children, out of which neonatal occurrences are <70 cases reported in the literature. 3Due to its rapid, fulminating course, missed diagnosis, and delayed treatment, it could drastically increase mortality rates by 50% in the neonatal age. 3 We report three neonatal presentations of necrotizing fasciitis, the course of the disease, and how meticulous treatment with prompt antimicrobial therapy and advanced plastic surgery alliances helped achieve complete recovery in all three babies.case descrIptIon