Individualised Wound Treatment Strategies for Skin Lesions Caused by Calcium Gluconate Extravasation in Neonates: A Case Report

Extravasation of calcium gluconate solution is a rare yet serious complication in neonatal intensive care units (NICUs), capable of causing significant skin necrosis, ulceration and long-term functional impairment. This study reports a case of such injury and describes an effective, individualised strategy for wound management. An 18-day-old, 4200 g male infant, diagnosed with hypocalcaemia (serum calcium: 1.6 mmol/L) at a hospital in China, experienced calcium gluconate extravasation following peripheral intravenous supplementation. This complication resulted in localised skin swelling, ulceration and necrosis. After eight days of unsuccessful conventional management, the infant was transferred to a tertiary maternity and children's hospital in Sichuan, China. We implemented a structured treatment protocol involving combined debridement to excise necrotic tissue and calcium deposits. The wound was then managed with a tailored regimen: Lipido-colloid dressings with silver ions were applied to control infection, alongside recombinant human epidermal growth factor gel to stimulate cellular regeneration. A moist wound environment was maintained using alginate hydrogel and foam dressings. The silver-containing dressings were discontinued after 10 days upon resolution of erythema and cessation of exudate. The infant was discharged after a 32-day course with satisfactory wound epithelialisation and full preservation of joint mobility. One-year follow-up confirmed normal limb function and the absence of scar contracture. A structured, individualised wound management strategy was effective in treating skin injuries resulting from calcium gluconate extravasation. The combination of surgical debridement, advanced wound dressings and adjunctive growth factor therapy facilitated tissue regeneration, promoted healing and supported functional recovery. An integrated protocol of surgical debridement, advanced wound dressings, and adjunctive growth factor therapy effectively fostered tissue regeneration, accelerated healing, and underpinned functional recovery.