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Case report
A novel role for milrinone in neonatal acute limb ischaemia: successful conservative treatment of thrombotic arterial occlusion without thrombolysis
  1. Stephanie Boyd1,2,3,
  2. Vibhuti Shah3,4 and
  3. Jaques Belik3,4
  1. 1Department of Neonatology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
  2. 2The University of Sydney, Camperdown, New South Wales, Australia
  3. 3Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Stephanie Boyd; stephanie.boyd{at}health.nsw.gov.au

Abstract

Acute neonatal limb ischaemia (NLI) is most frequently an iatrogenic complication, however, may also occur in utero due to thromboembolism. There is no widely accepted protocol for treatment of NLI and limited evidence to guide management. Thrombolysis and surgical management have been attempted, though both are associated with significant morbidities. Milrinone is a phosphodiesterase-3 inhibitor used for its vasodilatory effects on the systemic and pulmonary vasculature. There is also emerging evidence for benefit of milrinone in ameliorating ischaemia-reperfusion injury. The authors present a case report of a term infant with spontaneous perinatal acute limb ischaemia secondary to near-completely occlusive thrombosis of the right subclavian artery. The infant was successfully managed conservatively with milrinone without requirement for thrombolysis or surgical intervention. Milrinone represents a novel treatment option for neonates with acute limb ischaemia and consideration of a trial of milrinone prior to higher risk treatment options is warranted in this patient group.

  • neonatal intensive care
  • therapeutic indications
  • haematology (incl blood transfusion)
  • medical management
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Footnotes

  • Contributors All authors contributed to the design of the case report. SB prepared the draft manuscript. SB, VS and JB reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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