Congenital gangrene of the extremities in a newborn

Abstract

Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

“…Peripheral arterial ischemia and necrosis threaten the survival of premature newborns. Earlier studies have reported that peripheral arterial ischemia due to congenital ischemia can occur immediately after birth for reasons such as placental ischemia and is difficult to treat effectively [30]. Thus, it is difficult to conclude that nitroglycerin patches would be effective in treating all cases.…”

Lower-Limb Ischemia at Birth Because of Spontaneous Arterial Thrombosis

“…Medical management alone may not suffice to achieve limb salvage in cases where the level of vessel occlusion is in the proximal limb segment 20 . Of 5 cases of newborn upper-limb ischemia, Armstrong et al reported 1 amputation in a child with brachial artery occlusion and salvage of remaining 4 with finger and hand ischemia 7 .…”

“…TE phenomena presenting with established ischemic changes at the time of birth, as in our case, are far rarer. A literature search revealed that only about 32 such cases, known as "intrauterine" or "congenital" gangrene, have been reported [6][7][8][9][10][11][12][13][16][17][18][19][20][21][22][23] , highlighting the rarity of this presentation. The presence of ischemic changes at birth suggests some intrauterine insult to the fetus.…”

“…Pharmacologic agents used for enhancing blood supply to the affected tissues in neonatal limb ischemia have included heparin, low-molecular-weight heparin, urokinase, streptokinase, amlodipine, and local glycerine patch 11,[27][28][29][30][31] . Tissue plasminogen activator at 0.1 mg/kg/hour has been reported to be efficacious, but close monitoring for bleeding tendencies is essential 20 . Hyperbaric oxygen has also been used experimentally to salvage borderline viable tissues; however, it carries a risk of oxygen toxicity, and its use is limited to term infants 32 .…”

“…Hyperbaric oxygen has also been used experimentally to salvage borderline viable tissues; however, it carries a risk of oxygen toxicity, and its use is limited to term infants 32 . Medical management alone may not suffice to achieve limb salvage in cases where the level of vessel occlusion is in the proximal limb segment 20 . Of 5 cases of newborn upperlimb ischemia, Armstrong et al reported 1 amputation in a child with brachial artery occlusion and salvage of remaining 4 with finger and hand ischemia 7 .…”