18/08/2026
A Challenging Case of Extensive Neonatal Scalp Infection โ A Successful Multidisciplinary Outcome
I would like to share and appreciate the excellent multidisciplinary management of a challenging neonatal case at NeoKids Children Hospital.
A 50-day-old baby, delivered by C-section at Tharad, initially developed caput succedaneum along with a femur fracture, which was managed conservatively.
At 15 days of life, the baby presented to NeoKids Hospital with fever, sepsis, and severe scalp infection. Between day 15 and 25, the baby required two incision-and-drainage procedures, with approximately 50โ60 mL of pus drained from the scalp in this tiny baby. Despite drainage and regular dressings, the infection progressed, with an extensive scalp abscess, multiple openings, and large raw areas.
Considering the extent of tissue involvement, a Plastic Surgeon was consulted on day 25 for further wound management.
Our Nursing team played a crucial role in the overall management, with appropriate antibiotic therapy, close monitoring and control of sepsis, and adequate analgesia/sedation to facilitate repeated bedside wound care safely and comfortably.
From the Plastic Surgery side, meticulous bedside debridement and wound toileting were performed, with careful preservation of all viable tissue. Regular wound care and close monitoring were continued.
Over the subsequent 2โ3 visits, the inflammatory markers improved significantly, with CRP decreasing from 68 to 9 mg/L.
The multiple raw areas were managed conservatively with gentle tissue handling and bedside suturing wherever feasible. Closure was carefully planned with appropriate tension adjustment to avoid excessive tension on the wound and prevent compromise of the delicate scalp vascularity.
By 50 days of life, through coordinated multidisciplinary care, the baby achieved near-complete wound healing without requiring skin grafting or flap reconstruction.
This case beautifully highlights the importance of early recognition, aggressive control of infection, meticulous wound management, preservation of viable tissue, and timely multidisciplinary collaboration in extensive neonatal scalp wounds.
The successful outcome was possible because of the coordinated efforts of the *Neonatal Team, Plastic Surgeon, nursing team, and everyone involved in the baby's ongoing wound care*. It is a great example of how careful tissue preservation and timely intervention can sometimes prevent progression to deeper infection and avoid major reconstructive surgery.
What may initially appear to be a benign scalp swelling can occasionally evolve into a much more serious problem and warrants appropriate clinical assessment and follow-up.
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Learning: Never ignore a benign looking โcaput succedaneum,โ too!
Newborn babies are known for narrow safety window. Even a few minutes of delay can be life threatening and imprints a lifetime morbidity.
Our moto is not only survival but Intact Survival and Care Beyond Cradles.
