1. McKeown, Katherine E. BSN, RNC-NIC
  2. Baker, Rachel B. PhD, RN, CPN


Introduction: Methicillin-susceptible Staphylococcus aureus (MSSA) infections cause diseases ranging from localized skin infections to serious invasive infections. Neonates are immunosuppressed, placing them at increased risk for MSSA infections, including staphylococcal scalded skin syndrome (SSSS), a rare severe skin presentation of MSSA.


Clinical Findings: We present a case series of 3 preterm infants with SSSS receiving care at a level 3 neonatal intensive care unit.


Primary Diagnosis: The infants presented with symptoms of sepsis, including temperature instability, apnea, and bradycardia episodes. The infants had peeling skin at sites of external pressure, including peripheral intravenous (IV) sites, under dressings, or where devices had been in contact with skin.


Interventions: The infants were soaked in a tub with gel baby wash and water to remove leads without traumatizing the skin. Laboratory values were drawn, and cultures were obtained. Wound care was provided using mupirocin, soft silicone mesh wound contact layer, and soft cotton bandage gauze. Supportive respiratory care was provided, and IV antibiotics were administered.


Outcomes: The infants were discharged to their homes with intact skin. One infant experienced a loss of pigment that persisted several weeks. All patients were without scarring by early childhood.


Practice Recommendations: Thorough assessment and careful hygiene of neonates' skin is crucial. MSSA is an infection that can appear on the skin. It is important to quickly diagnose and treat this type of infection, especially when it presents as a localized pustule, boil, tear, peeling, or crust before it becomes systemic.