Fish-Skin Grafts Close Neonatal Wounds Fast | Case Series

Intact Fish Skin Grafts in Premature Neonates & Hospitalized Infants: Early Outcomes, Workflow, and Safety Signals

Medical education note: This article is for clinicians. Always follow your institution’s protocols and the device manufacturer’s instructions for use.

Quick take (TL;DR)

A pediatric woundcare team reported early experience using intact fish-skin grafts (IFSGs; derived from Atlantic cod) to treat complex wounds in premature neonates and hospitalized infants. After bedside wound-bed preparation and a single IFSG application left in place 7–14 days, complete closure occurred in all but one case, with an average time to closure of 17.2 days and no observed adverse effects. Gestational ages ranged from 21-week prematurity to term. Most infants required only one IFSG; a few needed two applications. (1,2)

Why this matters

(Complex neonatal wound of an infant)

Complex neonatal wounds (e.g., iatrogenic injuries, postoperative sites, extravasation injuries) are challenging: small surface area magnifies fluid and heat loss, dressing changes can be traumatic, and product safety data in this population are limited. This case series suggests IFSG may be a practical, well-tolerated option that accelerates closure while reducing handling frequency—key benefits in fragile patients. (1,2,6)

What the team did

Population: Premature neonates and infants cared for by a pediatric wound-care service; gestational ages from 21-week prematurity through term (see patient-detail panel and GA pie chart on the poster). (1,5)

Product: Intact fish-skin graft (Kerecis Omega3®) sourced from Atlantic cod. (1,5)

Setting & method: Bedside application after wound-bed preparation by two investigators; IFSG left in place for 7–14 days; sites assessed every 3–4 days for infection or intolerance. Primary endpoint: complete closure. (1,2)

Outcomes at a glance

Cohort size: Infants ranging from extremely premature to term (the series text reports 14 infants; the poster header summarizes data across a larger service experience). (1)

Applications: Most (11) achieved closure with a single IFSG; a subset required two applications. (1,3)

Effectiveness: Complete closure in all but one; mean time to closure 17.2 days. (1,3)

Safety: No adverse effects or complications observed during monitoring. Comparable pediatric series of acellular/intact fish-skin grafts in burns and acute wounds have likewise reported low complication rates. (2,3)

(Successful closure of wound using fish skin graft after 18 days)

Clinical workflow you can replicate

Prepare the bed: Perform gentle wound-bed preparation to remove non-viable tissue and optimize perfusion. (2,7)

Apply IFSG at bedside: Size to cover the wound; secure per local protocol. Leave undisturbed 7–14 days unless clinical changes require earlier inspection. (1,2)

Monitor q3–4 days: Assess for signs of infection or intolerance; reinforce dressings as needed; maintain thermoregulation and moisture balance. (2,6)

Reapply if needed: Most infants closed with a single application; a minority benefited from a second application, similar to other pediatric series using acellular fish-skin matrices. (2,3)

Track the endpoint: Complete closure was the primary endpoint in the series. Document time-to-closure and any events. (1,2)

What makes IFSG attractive in the NICU/PICU

Low handling frequency: A single placement designed to remain 7–14 days minimizes painful, disruptive dressing changes on extremely fragile skin. (2,6)

Early closure signal: A ~17-day mean closure supports shorter trajectories in select wounds and is directionally consistent with pediatric case series using fish-skin grafts for complex wounds. (1–3)

Favorable tolerability: No adverse effects were recorded in this series despite exposure in extremely premature infants, echoing the tolerability profile reported in other neonatal and pediatric fish-skin graft reports. (2,5)

Limitations (read before you generalize)

Uncontrolled case series from a single service; no comparator arm and potential selection bias.

Heterogeneous wounds: “Complex wounds” cover varied etiologies; applicability may differ by wound type and comorbidities. (2,3)

Protocol nuances: Outcomes reflect the investigators’ workflow (bedside prep, surveillance cadence), which may not mirror all settings. (1,2)

Practical tips for your unit

Build a pathway: Standardize candidate selection, consent, IFSG placement, and monitoring every 3–4 days. (2,7)

Document precisely: Record GA, weight, wound etiology, time-to-closure, and any events to enable QI review. (2)

Coordinate with pharmacy & nutrition: Optimize protein/energy intake and analgesia; these often co-determine closure speed in neonates and are emphasized in broader neonatal wound-care literature. (2,6)

Educate families: Explain that the graft remains in place up to two weeks and that minimal handling is intentional. (2)

References

1. Amaya R. Intact Fish Skin Grafts for Treatment of Complex Wounds in Premature Neonates and Hospitalized Infants. Poster presented at SAWC Fall 2025; listed in “Kerecis Fish-Skin Technology to Make a Splash at SAWC Fall 2025.”
   Link: https://www.kerecis.com/kerecis-fish-skin-technology-to-make-a-splash-at-sawc-fall-2025/

2. Cherry I, et al. Exploring the Place of Fish Skin Grafts with Omega-3 in Pediatric Wound Management. J Pediatr Surg. 2023.
   Link: https://pubmed.ncbi.nlm.nih.gov/38202119/

3. Ciprandi G, et al. Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series. J Wound Care. 2022;31(10):824–832.
   Link: https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2022.31.10.824

4. Staubach R, et al. The Use of Fish Skin Grafts in Children as a New Treatment of Deep Dermal Burns. J Clin Med. 2024;13(8):2389.
   Link: https://www.mdpi.com/2077-0383/13/8/2389

5. Ahn KH, et al. A rare case report of neonatal calcinosis cutis induced by distant and delayed extravasation of intravenous calcium gluconate. Arch Plast Surg. 2021;48(6):641–645. Describes use of Kerecis® acellular fish-skin graft in a neonatal wound.
   Link: https://pubmed.ncbi.nlm.nih.gov/34818711/

6. Marissen J, et al. The Delicate Skin of Preterm Infants: Barrier Function, Host Response and Clinical Implications. Neonatology. 2023;120(3):295–309.
   Link: https://karger.com/neo/article/120/3/295/836020

7. Di Mitri M, et al. Fish Skin Graft: Narrative Review and First Application for Complex Wound Defect. Plast Reconstr Surg Glob Open. 2023.
   Link: https://journals.lww.com/prsgo/fulltext/2023/09000/fish_skin_graft__narrative_review_and_first.32.aspx