Successful Early Surgical Treatment in Neonatal Compartment Syndrome: Case Report

Acute forearm compartment syndrome in a newborn caused by reperfusion after spontaneous axillary artery thrombosis

“…These are prematurity, asphyxia, maternal diabetes, polycythemia, necrotizing enterocolitis, acute respiratory distress syndrome, poor cardiac output, dehydration, congenital heart, and renal anomalies. Hereditary risk factors are deficiency of protein C and S, antiphospholipid antibodies, hyperhomocysteinemia, mutations for MTHFR C677T and A1298C, factor 5 G1691A, and prothrombin G20210A [4,9]. In our case, the mother had maternal diabetes and fetal distress occurred at birth.…”

“…Several congenital and acquired predisposing factors have been described in the etiology [1][2][3]. Neonatal forearm compartment syndrome is also a rare condition in the newborn period and mostly caused by congenital anomalies, infection, or difficult delivery [4,5]. To our knowledge, compartment syndrome because of reperfusion after thrombolytic treatment in the newborn period has not been described in the literature before.…”

Unusual Presentation of Compartment Syndrome

“…Local mechanical causes include umbilical cord loops, fetal posture and oligoamnios, twin pregnancy, maternal uterine malformation, and amniotic band constriction [22]. This mechanical compression can be accentuated by maternal and neonatal conditions such as respiratory distress, vascular insufficiency, clotting disorders, and maternal diabetes [23]. It should be distinguished from gangrene of the newborn (usually involves lower limbs) [24], from necrotizing fasciitis (fulminating course of sepsis and skin lesions), and from aplasia cutis congenital (congenital absence of skin; ulcers involving symmetrical scalp, trunk, and extremities; and heal spontaneously) [25].…”

Decompressive Fasciotomy in an Extremely Preterm Newborn with Compartment Syndrome

“…in rapidly deteriorating clinical conditions with a fulminating course of sepsis. 3,6,8 Possible treatment of neonatal compartment syndrome includes either urgent fasciotomy, if blood flow is compromised and the limb is swollen and tense, or, in case of extensive full-thickness necrosis and extreme contractures, surgical debridement with potential bone resection and skin grafts. [4][5][6] Emergency surgical decompression can achieve good results, but the time from birth to surgery seems to represent the main prognostic factor.…”

“…Neonatal compartment syndrome of an extremity is a rare condition that, without prompt intervention, leads to muscular and neuronal ischemia and long-term sequelae such as Volkmann ischemic contracture and limb growth deficit 1 The etiology remains poorly understood, as do management guidelines. [2][3][4] The classical clinical presentation includes erythema, cyanosis, skin discoloration, severe swelling, blisters, hemorrhagic bullae, and desquamated necrotic skin with ulceration and eschars, up to complete gangrene of an extremity. [4][5][6][7][8] Pulses are usually detectable, but capillary refill can sometimes be diminished.…”