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Paediatrics
Management of iatrogenic acute limb ischaemia in the neonate
  1. Dotan Shaniv1,2,
  2. Yael Simpson-Lavy1 and
  3. Calanit Hershkovich Shporen1,3
  1. 1 Neonatal Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
  2. 2 Pharmacy Services, Kaplan Medical Center, Rehovot, Israel
  3. 3 Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
  1. Correspondence to Dotan Shaniv; dotan.shaniv{at}mail.huji.ac.il

Abstract

Iatrogenic acute limb ischaemia (ALI) in neonates is a rare but severe event with potentially deleterious outcomes. In the neonatal intensive care unit, this risk is increased due to the high rate of catheterisation procedures. ALI management includes pharmacological and non-pharmacological interventions, but no commonly accepted clinical guidelines are available. In the present case, a peripheral catheter was erroneously placed in the left brachial artery of a term infant, causing blockage and ischaemia in the limb. The catheter was immediately removed, the affected limb was elevated and warm compresses were applied to the contralateral limb. The patient was treated with fresh frozen plasma, heparin, iloprost and topical nitroglycerin. Three nerve block procedures were also performed. At 6–8 days of age, significant improvement was observed. The patient was discharged at 17 days of age with near-complete resolution, whereas complete resolution was observed at postdischarge follow-up.

  • Arteries
  • Haematology (drugs and medicines)
  • Neonatal intensive care
  • Neonatal and paediatric intensive care
  • Therapeutic indications

https://doi.org/10.1136/bcr-2024-261775

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    Footnotes

    • X @DShaniv

    • Contributors The following author was responsible for drafting of the text, sourcing and editing of clinical images, investigation results and drawing original diagrams and algorithms: DS. The following authors were responsible for critical revision for important intellectual content: YS-L and CHS. The following author gave final approval of the manuscript: CHS.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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