ISCHAEMIA IN THE NEONATE–CASE REPORT
DOI:
https://doi.org/10.48750/acv.64Keywords:
Gangrene, Lower Extremity, NeonateAbstract
Introduction: Peripheral ischaemia and gangrene in a neonate is rare,with fewer than a hundred cases reported in the literature. Neonatal limb ischaemia present considerable challenges in diagnosis and management. The published literature is limited to case reports and case series and there are no large trials comparing different therapies.
Objectives: The authors describe the case of a 4-day newborn transferred to the Pediatric Hospital for a gangrene of the lower limb.
Results: In this case the member was not salvageable. Treatment with Heparin was performed which is usually effective in cases of neonatal limb ischaemia, but in this case the evolution was not favorable. The diagnosis was late and an amputation of the leg was performed. A multidisciplinary team of surgeons, paediatricians, occupational therapists, physiotherapists, working together provided the best support network and best treatment for this child.
Conclusions: Neonatal limb ischaemia is uncommon, but can have devastating consequences on the patient. Successful management is dependent on early recognition, rapid clinical assessment and appropriate therapy. Initial supportive therapy may be appropriate with aggressive interventional treatment reserved for selective cases. Interventional treatment includes thrombolysis using a tissue plasminogen activator which can be catheter directed or systemic, and surgical thrombectomy, particularly if larger vessels such as the abdominal aorta are involved. Strategies for management are still evolving, and there is only a limited pooled experience available for review in the published literature.
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References
of an infant of a diabetic mother. BJOG. 2003 Jan; 110:74-6
2. Long DK, Lorant D. Multiple arterial thrombi and in utero leg gangrene
in an infant of a diabetic mother. J Perinatol 2002; 22: 424-427
3. Valderrama E, Gribetz I, Strauss L. Peripheral gangrene in a
newborn infant associated with renal and adrenal vein thrombosis.
J Paediatr 1972 ;80: 101–103
4. Stuart MJ, Sunderji SG, Allen JB. Decreased prostacyclin production
in the infant of the diabetic mother. J Lab Clin Med 1981; 98: 412–416
5. Vasquez P, Burd A, Mehta R, et al. Resolution of peripheral artery
catheter-induced ischemic injury following prolonged treatment
with topical nitroglycerin in a newborn: a case report. J Perinatol
2003;23(4):348e50.
6. Al-Salem A, Naga M, et al. Neonatal gangrene of the extremity:
A report of three cases and review of the literature. Journal of
Pediatric Surgical Specialties 8.4-2014
7. Arshad A, McCarthy MJ. Management of limb ischaemia in the neonate
and infant. Euro J Vascular Endovascular Surg 2009; 38:61-5.
8. Kayssi, Ahmed, Shaikh F, Roche-Nagle G, et al. "Management of
acute limb ischemia in the pediatric population." Journal of vascular
surgery 60.1 (2014): 106-110
9. Friedman J, Fabre J, Netscher D, et al. Treatment of acute neonatal
vascular injuries e the utility of multiple interventions.J Paediatr
Surg 1999;34(6):940e5.
10. Theile RJ, Coombs CJ. Microvascular and thrombolytic revascularization
of an arm in a 32-week gestation neonate: case report and
review of the literature. J Reconstr Microsurg 1996;12(2):539e42
11. Stavorovsky M, Iellin A, Spirer Z. Acute ischemia of the limb in a
newborn treated successfully by thrombectomy. Am J Surg. 1975
Mar; 129:337-40.
