Neonatal Gangrene in the Newborn Infant of a Diabetic Mother

Hsi, Andrew; Davis, Donald J.; Sherman, Frederick C.

doi:10.1097/01241398-198505000-00021

Cited by 21 publications

(11 citation statements)

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“…Poorly controlled diabetes during pregnancy was an association in seven (15%) cases [6,21,23,42,43,45,46] and in two of these both renal and adrenal venous thromboses were present at necropsy [42,45]. It was previously shown that venous thrombosis, particularly renal and adrenal, occurred in almost 16% of stillbirths born to diabetic mothers compared with less than 1% in nondiabetic mothers [29].…”

Section: Maternal Diabetesmentioning

confidence: 94%

Peripheral ischaemia and gangrene presenting at birth

et al. 1992

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The aetiology of non-iatrogenic causes of peripheral ischaemia and gangrene presenting either at birth or within a few hours of delivery is unknown in the majority of 56 confirmed cases. In this review of 47 cases occurring since 1941 the aetiology was clear in only 6, four due to compression by the encircling umbilical cord. There was no clear association with gestational age, birth weight, maternal age or type of delivery. Seven were infants of poorly controlled diabetic mothers and these may constitute a subgroup due to altered haemostatic mechanisms. Pregnancy hypertension was an association in 7 cases, oligohydramnios in 6. There is only limited support for birth trauma, sepsis, and thrombo-emboli from the ductus arteriosus as causes. There is indirect evidence that thrombo-emboli can migrate from the placental bed to the fetus. In recent years death from this condition has been rare with surgical thrombectomy increasingly successful in late presenting cases. When gangrene is established at birth surgical amputation, autoamputation, or some loss of function is usual. Peripheral ischaemic insults presenting at birth may be part of a wider spectrum of disorders, both prenatal and perinatal, attributable to occlusive vascular disruption.

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Section: Maternal Diabetesmentioning

confidence: 94%

Peripheral ischaemia and gangrene presenting at birth

et al. 1992

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“…12 Hsi et al notes that over half of the reported cases of neonatal extremity gangrene presented in the first day of life despite a lack of evidence of prolonged in utero thrombosis. 13 Prompt clearance of the thrombus is thus vital, not only to salvage the limb, but also to preserve limb function and prevent long-term complications including limb growth discordance and exercise-induced claudication. 7,8 Generally, accepted management of a limb or life-threatening thrombus is the use of fibrinolytics-generally rt-PA-in combination with heparinization.…”

Section: Discussionmentioning

confidence: 99%

Emergent Thrombectomy in a Neonate with an Upper Extremity Arterial Thrombus

2014

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Case This case report is of a 39 4/7weeks infant who presented at the time of birth with an immobile, cyanotic right upper extremity consistent with ischemia but without evidence of gangrene. Doppler examination identified pulses in the axillary but not the brachial or radial arteries. Extremity arterial ultrasound confirmed the diagnosis of an arterial thrombosis extending from the right axillary artery to the brachial artery bifurcation. An emergent balloon thrombectomy was performed successfully with immediate return of blood flow. Intraoperative ultrasound demonstrated patent axillary and brachial arteries with forward flow. A retroperitoneal ultrasound and limited hypercoagulable workup failed to identify a source of the arterial thrombus. The infant had normal return of function without residual limb effects. Conclusion Emergent balloon thrombectomy should be heavily considered in neonates with an extremity arterial thrombosis of undeterminable duration both for limb salvage, preserve function, and to prevent long-term growth discordance.

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“…Various conditions have been implicated as a cause for the ischaemic episode. Thromboembolism may be a cause and may be associated with maternal diabetes 2–8 . In most instances, the diabetes was poorly controlled.…”

Section: Discussionmentioning

confidence: 99%

“…If gangrene is not well established and ischaemia appears to be of recent onset, anticoagulation and thrombectomy should be considered. Hsi et al 4 also suggest in some cases fasciotomy to prevent massive muscle necrosis of the forearm.…”

Section: Discussionmentioning

confidence: 99%

Neonatal gangrene in an extremity of an infant of a diabetic mother

Moazzam¹,

Riaz

Brennen

2003

BJOG

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A male infant, weighing 2.75 kg, was born to a 22 year old insulin-dependent diabetic woman, at 36 weeks of gestation. The mother was a carrier of metachromatic leucodystrophy and had a poor obstetric history of four miscarriages and one therapeutic abortion. The mother was commenced on insulin after her previous gestation. Her last gestation resulted in therapeutic abortion as amniocentesis had shown the baby to be affected with leucodystrophy.The mother had previously been treated with fluoxetine for depression. She smoked 10 cigarettes per day. Her diabetes was poorly controlled as was evident from glycosylated haemoglobin concentration of 10.1% in the middle trimester. An ultrasound scan was performed at 15 weeks of gestation with amniocentesis to exclude metachromatic leucodystrophy. At 26 weeks of gestation, she was receiving biphasic isophane insulin (PenMix 30/70) 24 units in the morning and 20 units at night. Her blood glucose concentrations were between 6 and 8 mmol/L. The results of the amniocentesis were normal. In view of the past poor obstetric history, an elective caesarean section at 38-39 weeks was arranged. However, she was admitted in labour at 36 weeks of gestation. Four hours later, her infant son was born spontaneously. He cried at birth. There were no cardiotocographic abnormalities in labour. The umbilical cord was not twisted around the infant's body or limbs. There were no placental infarcts. The infant had hypoglycaemia (0.6 mmol/L) which was treated with intravenous glucose.An area of necrosis on the left forearm and hand was noted by the delivery team and a plastic surgical opinion was sought. Examination of the forearm revealed an oblique demarcation between healthy looking skin and brown discoloured forearm and hand. This was distal to the junction of the upper and middle thirds of the forearm.There was no groove or depression at the level of the demarcation and no constriction bands on any of the other limbs. The forearm and hand felt soft and jelly-like. They were of comparable size to the opposite limb and did not bleed on pinprick. The appearance of the forearm and hand suggested that the limb had been ischaemic for several weeks in utero (Fig. 1).The baby had a cardiac murmur. Both axillary and femoral pulses were palpable. The electrocardiogram and echocardiogram were normal. A consultation by the paediatric cardiology team excluded any structural cardiac abnormality, and a distal vascular occlusion or embolus Fig. 1. Appearance of the forearm at seven days of age.

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Neonatal Gangrene in the Newborn Infant of a Diabetic Mother

Cited by 21 publications

References 0 publications

Peripheral ischaemia and gangrene presenting at birth

Peripheral ischaemia and gangrene presenting at birth

Emergent Thrombectomy in a Neonate with an Upper Extremity Arterial Thrombus

Neonatal gangrene in an extremity of an infant of a diabetic mother

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