Topical nitroglycerin in neonates with tissue injury: A case report and review of the literature

Successful Management of Severe Peripheral Tissue Ischemia after Arterial Catheterization in Micro Preemies using Humidification & Topical Nitroglycerin

“…그러나 드물지만 동맥 카테터 삽입으로 인해 이차 적으로 혈종, 혈전색전증, 혈관경련수축, 관류장애에 따른 조직허혈이나 말초신경의 손상, 정맥 염 등과 같은 합병증이 발생할 수 있으며, 적절한 치료를 받지 못할 경우 급속하게 괴사로 진행 되어 영구적인 손상을 남길 수 있다 2,3) . 특히 초극소 미숙아의 경우 혈관 지름이 카테터 사이즈와 비교하여 상대적으로 작기 때문에 위와 같은 합병증에 더욱 취약하며, 합병증 발생시 심각한 후 유증을 남길 가능성이 높다 4) . 동맥 카테터 삽입으로 인한 조직 허혈의 표준치료는 원인이 되는 카테터를 즉시 제거하고 반 대편에 따뜻한 물이나 수건으로 온찜질을 하여 반사적 혈관확장을 유도하면서 심장의 위치보다 병변 부위를 높게 유지하는 것이다.…”

Topical nitroglycerine in management of peripheral ischaemia in a neonate following arterial cannulation

“…The rate of absorption depends on the quantity and the surface area 3 . Though rare, the potential side effects are tachycardia, hypotension, flushing and methaemoglobinaemia 2,3 . Preterm neonates are more prone to these adverse effects because their immature epidermal layer facilitates more drug absorption compared to a term baby 3 .…”

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

“…Immediate and non-invasive methods of treating peripheral tissue ischemia and areas of necrosis include evaluating the need for catheters in blood vessels and removing them, elevating the limbs of the relevant areas, applying heating on the limb where thrombosis has not occurred, and performing soft massages [2,5,7]. However, some researchers, such as Samiee-Zafarghandy, van den Anker, and Ben Fadel [8] and Han, Song, Sung, and Chun [9], reported that tissue ischemia and necrosis did not improve after implementing non-invasive treatment methods, meaning that these techniques have limitations in the treatment of peripheral tissue ischemia and necrosis. In contrast, nitroglycerin patches, anticoagulants, thrombolytic agents, and mechanical thrombectomy, which are also treatments for ischemia in newborns, are regarded as secondary treatment methods due to their high hemorrhage risks [5].…”

“…As an organic nitrate drug, nitroglycerin patches are used to treat skin tissue ischemia and necrosis because nitroglycerin expands blood vessels in arteries and veins, and local application of a nitroglycerin patch takes effect in vascular smooth muscles to immediately expand blood vessels and improve peripheral circulation [10][11][12]. Many earlier studies have applied nitroglycerin sprays or ointment as potential methods of treating peripheral arterial ischemia and necrosis in newborns [2,5,8,11,13].…”

“…Nonetheless, few studies have implemented nitroglycerin treatment and investigated a diverse range of related factors in premature newborns with peripheral arterial ischemia or necrosis [5]. Moreover, few studies have investigated the effectiveness of treatment of necrosis using nitroglycerin patch-es as opposed to nitroglycerin ointment or sprays [2,8]. Nitroglycerin patches are cheap and are distributed with a standard size; however, a single patch can be divided into multiple patches of various sizes, enabling it to be used more than once.…”