Background Arterial catheterization is frequently performed in neonatal intensive care units with an inherent risk of peripheral ischemic injury, especially in preterm infants. The treatment options following vascular damage involve invasive and non-invasive modalities. The primary objective of this systematic review was to evaluate the evidence of the use of topical nitroglycerine (TNG) either alone or as adjunctive therapy. The secondary aim was to develop an approach to the treatment of catheter induced ischemia in infants based on the available evidence. Methods A comprehensive search was conducted of available databases for relevant articles that involved the treatment of peripheral tissue ischemia in neonates with the use of TNG. Citations were restricted to human subjects. Results Six hundred and eighty-nine articles were identified, and twenty-seven case reports and case series were compatible with the inclusion and exclusion criteria. Sixty-eight infants out of the 76 published cases (89%) experienced a favorable outcome and 79% (n = 60) demonstrated complete recovery with the topical application of TNG to the ischemic site. Conclusion The available evidence demonstrates that TNG is effective for the treatment of peripheral ischemia in neonates after standard conservative measures have failed. However, due to the absence of robust evidence for this therapeutic modality, there are no uniform guidelines regarding the frequency, duration, and safety of TNG use. Planning the management of peripheral ischemia in neonates with TNG should be a multidisciplinary decision that includes close surveillance of blood pressure, methemoglobin levels, and follow up cranial ultrasound.

The coronavirus disease-2019 (COVID-19) is usually less severe and less prevalent in the pediatric population. Children with preexisting conditions such as neuromuscular impairments and chronic lung disease are more susceptible to COVID-19 and may incur several complications with a poor outcome. We present a case report of a 3-year-old-female with generalized hypotonia and respiratory failure due to spinal muscular atrophy who tested positive for COVID-19 and developed multisystem inflammatory syndrome that was treated with intravenous immunoglobulin and tocilizumab and subsequently died. The report highlights the importance of close surveillance, the use of protective measures during hospital visits, early testing, and diagnosis of COVID-19 in children with neurological disorders.

When we set ourselves a clinical question-probably using the PICO frame, we mostly do not think about the 'scope' of what we are doing. It is instinctive. But like lots of unconscious actions, it is frequently helpful to expose them to a bit of critical thinking.Take a question about C reactive protein (CRP) thresholds to perform, or not, a lumbar puncture in a neonate with fever and the possibility of infection. You might frame your PICO as 'In neonates with suspected sepsis (P), does a CRP threshold of >20 mg/L (I) compared with >10 mg/L (C) diagnose as many babies with meningitis (O)?' Not a unreasonable question to ask, not clearly 'limited' beyond maybe wondering if a different set of numbers would be better to use instead.What the question does not do is explore the underlying assumptions: that diagnosing meningitis will lead to treatment change in some way, that an undocumented meningeal infection will lead to negative consequence, or that the act of lumbar puncture may affect how the child is viewed, and their health fragility, for the whole of their childhood and maybe beyond. These are beyond the scope of the question. It is never wrong to scope-indeed we have to, or every question would be 'When I act, or not, will the universe be better or worse for the whole of eternity?' It is worth thinking what the edges of our box are though, and sometimes questioning if we have the edges in the right place.