Soft tissue injury associated with intravenous phenytoin in a neonate

A term baby with neonatal convulsions secondary to birth asphyxia was given iv phenytoin via a cannula in the dorsum of the hand at 17 h of age. She developed a blue discolouration in the tissues surrounding the iv site. The infusion was aborted but the discolouration gradually spread to the rest of the hand. Twenty hours later, improvement could be detected although a blister appeared near the iv site. A further attempt two days later to administer phenytoin via an iv cannula sited in the left foot was aborted after the appearance of a similar reaction.