Neonatal compartment syndrome

Abstract

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

Serious Complications of Intraosseous Access during Infant Resuscitation

“…The most common site of occurrence is on the leg. 4 5 6 7 Late diagnosis of this complication is not uncommon and logically has worse outcomes. The consequences of this complication may be very serious; the loss of the limb is rare.…”

Neonatal Extremity Compartment Syndrome: A Rare Diagnosis Requiring Prompt Recognition

“…2,4 Risk factors that predispose infants to a hypercoagulable state (sepsis, thrombophilic disorders, maternal diabetes) or trauma (fetal macrosomia, difficult/traumatic birth extraction, oligohydramnios, amniotic band syndrome) have been implicated, but the exact cause of NCS remains poorly understood. [2][3][4][5] The severity of NCS ranges from transient ischemia causing minimal damage to severe compartment syndrome causing growth restriction, severe contracture, loss of limb function, and limb necrosis. 5 A previous case series and literature review of NCS reported at long-term follow-up 84% of infants had persistent contracture, 82% had radiographic bony abnormalities, and 45% had persistent nerve dysfunction.…”

“…[2][3][4][5] The severity of NCS ranges from transient ischemia causing minimal damage to severe compartment syndrome causing growth restriction, severe contracture, loss of limb function, and limb necrosis. 5 A previous case series and literature review of NCS reported at long-term follow-up 84% of infants had persistent contracture, 82% had radiographic bony abnormalities, and 45% had persistent nerve dysfunction. 2,4 Multiple publications have showed that ear-lier surgical intervention is associated with better functional outcomes.…”

“… 2 3 Nearly all reported neonatal cases involved the upper extremities, and the affected limb presented with significant swelling and sentinel skin changes such as desquamation, blister/bullae formation, and skin necrosis. 2 3 4 5 6 7 8 These skin findings are thought to reflect underlying tissue ischemia secondary to an increased interstitial pressure within a confined compartment. 2 4 Risk factors that predispose infants to a hypercoagulable state (sepsis, thrombophilic disorders, maternal diabetes) or trauma (fetal macrosomia, difficult/traumatic birth extraction, oligohydramnios, amniotic band syndrome) have been implicated, but the exact cause of NCS remains poorly understood.…”

Decompressive Fasciotomy in an Extremely Preterm Newborn with Compartment Syndrome

“…Neonatal compartment syndrome of an extremity is a rare condition that, without prompt intervention, leads to muscular and neuronal ischemia and long-term sequelae such as Volkmann ischemic contracture and limb growth deficit 1 The etiology remains poorly understood, as do management guidelines. [2][3][4] The classical clinical presentation includes erythema, cyanosis, skin discoloration, severe swelling, blisters, hemorrhagic bullae, and desquamated necrotic skin with ulceration and eschars, up to complete gangrene of an extremity. [4][5][6][7][8] Pulses are usually detectable, but capillary refill can sometimes be diminished.…”