Review of the safety of use of silver dressings for burns in children under 4 years of age.

Dr Charlotte Blau1,2,  Dr Jessica Papalii-Curtin,1, Mr Barnaby Nye1,2

1Christchurch Hospital, Christchurch, New Zealand, 2University of Otago, Christchurch, New Zealand


BACKGROUND: Silver (Ag) dressings are commonly used in management of paediatric burns. Adverse events such as leukopenia, hepatotoxicity and renal impairment post application of silver dressings, and silver deposition in internal organs in animal studies could be of concern. Guidance for the use of Ag products on children under 4 does not appear to be well described. We review the literature to describe the safety of silver dressings in children under 4 years.
METHODS: A search on Medline was performed with the subject headings [“child” OR “paediatric” OR “Neonate”] AND “burns” AND [“silver” or “mepilex Ag” or “acticoat” or “aquacel Ag” or “silver sulfadiazine”]. The inclusion criteria were: English, burns, paediatric population, use of silver dressings and reporting of wound outcomes.
RESULTS: 26/145 articles met the inclusion criteria and were included in the review. Two studies explicitly reported use of Ag dressings on under 4 year olds. Two studies reported on neonates, and one on premature neonates. EIghteen concluded positive outcomes with Ag dressings, while three reported better outcomes with membrane dressings. Six studies reported silver-specific outcomes in children (leukopenia, detectable serum silver)
CONCLUSION: This review highlights the absence of any firm evidence to deter practitioners from using Ag in the use in burns for under 4 year olds, including neonates, questions remain regarding long term safety of use in this population.


Dr Blau is a NZ plastics SET trainee currently based at Christchurch hospital.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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