Management of Limb Ischaemia in the Neonate and Infant

Abstract

A Pubmed search and an Ovid Medline/Embase search were both performed. The keywords were: 'neonatal' or 'paediatric' or 'pediatric' and 'limb' and 'ischemia' or 'ischaemia' and relevant articles were retrieved and analysed. Articles pertaining to children over the age of 3 years and non-English literature articles were excluded.

Intrauterine Upper Limb Ischemia Associated with Fetal Thrombophilia: A Case Report and Review of the Literature

“…The limb should be kept clean to prevent secondary infection. Hydration, nutrition, and antibiotics are widely accepted [3,4]. If the limb is still viable, but ischemic, and the duration of insult is short term, then systemic thrombolysis or catheter-directed thrombolysis may be considered.…”

“…In the majority of cases, arterial thrombosis that occurs during the postnatal period is caused by invasive monitoring of a sick neonate via an arterial umbilical catheter or repeated arterial blood sampling [2]. A limited number of in utero arterial thromboses with evidence of limb ischemia are described in the literature [1,2,3,4,5,6,7,8,9,10,11]. It was reported that these ischemic insults appear to predominate in the upper limbs and cases are equally divided between left and right sides, and are more predominant in males [4].…”

“…Anticoagulants, vasodilators and hyperbaric oxygen may improve the circulation in the affected limb and have been used in some cases. In cases of tissue necrosis, surgical amputation should be delayed for as long as possible because it is not easy in the neonate to predict how much function will recover spontaneously [2,3,4,7,8]. After amputation has ensued, splinting and range of motion exercises help prevent joint contracture.…”

“…The precipitating events causing intrauterine limb ischemia can be classified into arterial compression, which is caused by an extrinsic source, and in utero thrombo-embolic phenomena [3]. The identified causes for intrauterine arterial compression with evidence of limb ischemia and eventually gangrene include oligohydramnios, amniotic bands, uterine anomalies, and fetal malpresentation such as limb prolapse [4,5,6,7,10].…”

Peripheral blockade as treatment of arm ischaemia at birth

“…Its rare occurrence at birth makes it difficult to obtain an early diagnosis and treatment [3]. The aim of our case report was to alert neonatologists, anaesthetists and gynaecologists about the potential precocious occurrence of LI immediately after birth, in order to carry out prompt treatment by means of a peripheral nerve blockade (PNB), which according to our experience, could represent an effective and safe therapeutic approach.…”