Convective burn from use of hairdryer for heel warming prior to the heel prick test - a case report

We report the case of a five day old infant who sustained burns to the left foot and leg after the mother's hairdryer was used by the midwife to warm the baby's heel prior to capillary blood sampling (CBS) with an automated device.Heel warming is not recommended for routine CBS although it is often practiced. If pre-warming is to be practiced, standardised devices should be used rather than improvised techniques. This will reduce the risk of injury to these infants.Capillary blood sampling (CBS) is routinely offered to all newborn infants born in the United Kingdom to identify babies who may have rare but serious conditions for example phenylketonuria, congenital hypothyroidism, or cystic fibrosis. CBS uses dried spots of blood obtained by heel prick and collected on filter paper. Current blood spot sampling guidelines suggest that additional warming of the foot is not required before heel puncture but that the heel should be warm [1]. Although the heel prick procedure is relatively easy to complete, a recent study has highlighted great variability in the technique among midwives [2]. Problems with CBS still exist including pain for the baby [3], anxiety for the parents [4] and complications from mild bruising [5]. The case reported below describes the injuries sustained by a five day old infant after heel heating.A five day old baby presented with burns to the left foot and leg after having a heel prick test performed. A community midwife had visited the parents' home four hours earlier and to facilitate blood sampling, had used the mother's hairdryer to warm the baby's foot. The hairdryer was set on a high setting and was held about six inches from the baby's foot for less than one minute. The baby became distressed as soon as the heel prick was administered, and it was an hour after the procedure when the baby was finally consoled that the mother noticed erythema and blistering over the baby's foot and leg.On examination the baby had serous blistering over all th