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Acute neonatal arterial occlusion: is thrombolysis safe and effective?

Acute neonatal arterial occlusion: is thrombolysis safe and effective?
Acute neonatal arterial occlusion: is thrombolysis safe and effective?
Purpose

We report our experience of the management of arterial occlusion in the newborn.

Methods

A case note review was carried out after ethical approval. Doppler ultrasonography confirmed the occlusion. Thrombolysis was the primary intervention. Surgery was used selectively. A good outcome was one without tissue loss or functional impairment or minimal tissue loss without functional impairment. Data are presented as medians with ranges.

Results

Ten patients (9 male; median gestational age, 35.5 weeks [range, 28-39 weeks]) presented on day 1 (range, 1-8 days). Initial management included systemic tissue plasminogen activator (8 patients) and surgery (2 infants in whom thrombolysis was contraindicated). Improvement was noted in 7 of 8 infants treated medically and in both who underwent surgery. Three infants had significant tissue loss. Outcome at 29 months (range, 1.3-95.4 months) was good in the remaining 7.

Conclusions

A multidisciplinary approach, thrombolysis and selective surgery achieved tissue preservation and function in the majority while minimizing complications. Early referral to centers with multidisciplinary teams is recommended.
ischemia, limb, doppler, surgery, thrombolysis, newborn
0022-3468
1827-1832
Ade-Ajayi, Niyi
fc7fcd4c-cb7f-4c5b-843c-14e651ae4848
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Liesner, Ri
3a9faedf-a337-4925-9af0-880a2a0fbbf9
Kiely, Edward M.
40af8c7d-a7f7-4017-bc6e-39f53ee90508
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Roebuck, Derek J.
ada767e3-8526-432d-a53d-0991bcdb5d87
Drake, David P.
1d035b50-5ccd-46a5-93b8-75c120310293
Ade-Ajayi, Niyi
fc7fcd4c-cb7f-4c5b-843c-14e651ae4848
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Liesner, Ri
3a9faedf-a337-4925-9af0-880a2a0fbbf9
Kiely, Edward M.
40af8c7d-a7f7-4017-bc6e-39f53ee90508
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Roebuck, Derek J.
ada767e3-8526-432d-a53d-0991bcdb5d87
Drake, David P.
1d035b50-5ccd-46a5-93b8-75c120310293

Ade-Ajayi, Niyi, Hall, Nigel J., Liesner, Ri, Kiely, Edward M., Pierro, Agostino, Roebuck, Derek J. and Drake, David P. (2008) Acute neonatal arterial occlusion: is thrombolysis safe and effective? Journal of Pediatric Surgery, 43 (10), 1827-1832. (PMID:18926215)

Record type: Article

Abstract

Purpose

We report our experience of the management of arterial occlusion in the newborn.

Methods

A case note review was carried out after ethical approval. Doppler ultrasonography confirmed the occlusion. Thrombolysis was the primary intervention. Surgery was used selectively. A good outcome was one without tissue loss or functional impairment or minimal tissue loss without functional impairment. Data are presented as medians with ranges.

Results

Ten patients (9 male; median gestational age, 35.5 weeks [range, 28-39 weeks]) presented on day 1 (range, 1-8 days). Initial management included systemic tissue plasminogen activator (8 patients) and surgery (2 infants in whom thrombolysis was contraindicated). Improvement was noted in 7 of 8 infants treated medically and in both who underwent surgery. Three infants had significant tissue loss. Outcome at 29 months (range, 1.3-95.4 months) was good in the remaining 7.

Conclusions

A multidisciplinary approach, thrombolysis and selective surgery achieved tissue preservation and function in the majority while minimizing complications. Early referral to centers with multidisciplinary teams is recommended.

Full text not available from this repository.

More information

Published date: October 2008
Keywords: ischemia, limb, doppler, surgery, thrombolysis, newborn
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 378472
URI: https://eprints.soton.ac.uk/id/eprint/378472
ISSN: 0022-3468
PURE UUID: 74d19f8f-9063-438a-a148-8c57ba3d4ead
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

Catalogue record

Date deposited: 07 Jul 2015 16:32
Last modified: 06 Jun 2018 12:31

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