Neonatal limb ischemia - treatment modalities and sharing experience

Neonatal acute limb ischemia is an acute emergency condition which puts the infant at a risk for serious complications and adverse outcomes such as limb dysfunction and even amputation.

Practices vary, and accumulated experience is relatively limited, since due to the rarity of this condition, it is based on sporadic cases and small case series (no RCTs or large-scale observational studies).

We have had such a case a couple of years ago which resolved successfully. We seized this opportunity to review the literature and produce a summary of available modalities and published it in BMJ Case Reports. Here is the figure summarizing treatment modalities:

Figure 3

Summary of available treatment modalities for ALI. It is recommended that the left-hand branch of the figure be maintained throughout the treatment; the middle branch should be implemented according to clinical status and available options and be adjusted according to the response of the patient; and the right-hand branch should be considered on a case-by-case basis with regard to the risk-to-benefit ratio. Figure is prepared by DS. *To be performed by a qualified specialist. †Usually not recommended in neonates; decision should be based on patient characteristics, clinical status and multidisciplinary consultation. ALI, acute limb ischaemia; LMWH, low-molecular-weight heparin; PNB, peripheral nerve block; tPA, tissue plasminogen activator; UFH, unfractionated heparin.

We currently advise other units according to our experience. I hope this will help manage other similar cases.

All are welcome to share their own experiences with acute limb ischemia in the NICU.