Necrotic Skin Lesions and Cerebral Infarction in the Newborn: Two Case Reports

Abstract

Localized skin necrosis with deeper soft tissue injury at birth is unusual and has been rarely reported in association with cerebral infarction. Two cases with forearm necrotic skin associated with injured deeper soft tissue are described in which brachial artery thrombosis was documented. Considering the possibility of disseminated thrombosis, cerebral ultrasound showed brain infarction due to unilateral middle cerebral artery thrombosis on Doppler. The origin of the embolism was identified in the inferior vena cava and umbilical and portal vein. No thrombophilia or other risk factors were identified. The various causes of the cutaneous lesions pointed to an antenatal process whose etiology and mechanisms are discussed. Localized necrotic skin lesions must be considered as part of a systemic embolic process and can lead to extensive especially cerebral ultrasound exploration.

Spontaneous neonatal arterial thromboembolism

“…Infant weights were reported in only 35% (29/83) of the cases and ranged from 890 to 4760 g (mean 2919.7 g) [1,[3][4][5][6]9,12,[27][28][29]31,34,[36][37][38][39][40][41][42][43]. Infant weights were reported in only 35% (29/83) of the cases and ranged from 890 to 4760 g (mean 2919.7 g) [1,[3][4][5][6]9,12,[27][28][29]31,34,[36][37][38][39][40][41][42][43].…”

“…Seven articles address the presence of meconium at deliveries in which spontaneous arterial thromboembolism was noted [9,11,27,29,36,41,54]. Turnpenny et al [29] postulated that prior to delivery, the fetus experiences ischemic pain causing passage of meconium, which is subsequently incorporated into the eschar of the devitalized tissue and forms the source for the embolus.…”

“…Nevertheless, the ductus arteriosus is cited as a risk factor in five of the reviewed articles [1,34,37,39,43]. In the prenatal period, emboli originating in the venous system of the splanchnic or umbilical vessels could also migrate through the foramen ovale and enter the systemic circulation with similar consequences [27,40,68,69] including cerebral stroke as a secondary event [9,29,50].…”

“…Arterial thromboses represent almost 50% of all neonatal thrombotic events [7] and are recognized as a cause of significant morbidity and mortality. Several case reports and case series of embolic phenomenon in children document an association with the use of vascular access devices [1][2][3][5][6][7][8][9][10]13,19,[27][28][29][30][31][32][33]; however, relatively few address the occurrence of spontaneous arterial thromboembolism in neonates.…”

“…The literature search yielded 172 articles, 27 of which met the inclusion criteria for neonatal spontaneous arterial embolism [1][2][3][4][5][6]9,11,12,18,20,25,[27][28][29]31,[34][35][36][37][38][39][40][41][42][43][44] (Fig. 1).…”