Original articleAcute neonatal arterial occlusion: is thrombolysis safe and effective?
Section snippets
Materials and methods
All infants admitted under the care of a general pediatric surgeon with acute, limb-threatening, arterial ischemia in the 9-year period up to July 2003 were identified. Infants with a corrected gestational age greater than 44 weeks at presentation were excluded. A retrospective case note review of the remainder was undertaken. Evaluation included demographic details, mode of presentation, and clinical and radiologic assessment of extent of ischemia. The time to start treatment (TT) was defined
Results
Ten patients (9 male) were identified. The median gestational age was 35.5 weeks (range, 28-39 weeks), and the median age at presentation was 1 day (range, 1-8 days). Six infants had undergone intraarterial cannulation; 5 umbilical artery catheters in the 5 newborns who presented with lower limb ischemia and 1 left brachial artery catheter in 1 infant with ischemia of the left forearm and hand. Three of the 10 infants were born to diabetic mothers and 7 were born by emergency cesarean delivery.
Discussion
Acute limb-threatening arterial occlusion is a rare neonatal event [4], [5]. There is a lack of consensus regarding etiology and management [4], [6]. In this series, putative risk factors included an intraarterial catheter (6 infants), sex (9 male), emergency cesarean delivery (7 infants), and maternal diabetes, or very high body mass index (4 mothers). Although iatrogenic vascular injuries have long been recognized as a risk factor for limb ischemia in infants and young children [7], the
Acknowledgments
The authors wish to thank Dr Kate Head and Dr Miguel Guelfand for help with data collection.
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