PT  - JOURNAL ARTICLE
AU  - Stephanie Boyd
AU  - Vibhuti Shah
AU  - Jaques Belik
TI  - A novel role for milrinone in neonatal acute limb ischaemia: successful conservative treatment of thrombotic arterial occlusion without thrombolysis
AID  - 10.1136/bcr-2019-232440
DP  - 2019 Dec 01
TA  - BMJ Case Reports
PG  - e232440
VI  - 12
IP  - 12
4099  - http://casereports.bmj.com/content/12/12/e232440.short
4100  - http://casereports.bmj.com/content/12/12/e232440.full
SO  - BMJ Case Reports2019 Dec 01; 12
AB  - 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.