200 Section - The Role of Early Rehabilitation in Neonatal Calcium Extravasation: Two Case Reports

Case Diagnosis: Severe neonatal intravenous calcium extravasation injury leading to calcinosis cutis, tissue necrosis, and potential long-term functional impairment.

Case Description: We report two severe cases managed with multidisciplinary care and early rehabilitation, including lymphatic drainage massage, range-of-motion exercises, and strengthening training. Case 1, a preterm female, developed local hand necrosis following calcium chloride infusion. With early physical therapy and wound care, she regained normal function before discharge. Case 2, a full-term male, presented with extensive thigh swelling after calcium gluconate infusion via a peripherally inserted central catheter. MRI confirmed muscle calcification. With intensive rehabilitation and antibiotic therapy, he fully recovered within eight weeks. Both patients demonstrated significant functional and cosmetic improvement without requiring surgical intervention.

Discussions: To contextualize these outcomes, we conducted a systematic review of 9 articles (34 pediatric cases). The literature identifies extravasation as a medical emergency requiring immediate catheter removal, elevation, and cold compression. Early interventions (< 6 hours), such as hypertonic glucose wet dressings or micropuncture, may reduce calcification. While pharmacological consensus is lacking, topical sodium thiosulfate and intralesional triamcinolone show potential. Surgical reconstruction (e.g., Versajet debridement, negative pressure wound therapy, or grafting) is typically indicated for complications like necrosis or compartment syndrome. However, our cases demonstrate that early rehabilitation can effectively manage these injuries and may reduce the need for such invasive procedures.

Conclusions: Rehabilitation is an integral component of the multidisciplinary management of calcium extravasation. Early and active physical therapy helps prevent severe sequelae, such as joint contractures and functional limitations, potentially avoiding unnecessary tissue necrosis and surgical reconstruction.