Topical nitroglycerin in newborns with ischemic injuries: A systematic review

Abstract

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.

Mitigating nipple areolar complex (NAC) ischemia following mastopexy augmentation using nitroglycerin application and methylprednisolone: a case report

“…The proposed mechanism of action for nitroglycerin in this setting is venodilation of patent vessels draining the NAC, which alleviates venous congestion and allows for greater tissue oxygenation. Additionally, arterial vasodilation of patent vessels supplying the NAC compensates for decreased blood flow from superficial vessels that may have been damaged intraoperatively or due to postoperative inflammation [ 2 ]. Topical nitroglycerin is rapidly acting, requiring only 5–10 min for full transdermal absorption, making it an ideal choice in acute care settings [ 3 ].…”

Clinical aspects of umbilical cord cannulation during transfer from the uterus to a liquid-based perinatal life support system for extremely premature infants a qualitative generic study

“…Evidence of lidocaine’s effect on vasospasm is contradictory and may therefore not be used in lamb experiments [ 37 ]. In addition, nitroglycerine was discussed as vasodilator, but this has not been mentioned in lamb experiments [ 38 , 39 ] and little experience was present within the experts [F1].…”

Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysis

“…Hence, any infant or child who receives topical NTG should be monitored with blood gas analysis including methaemoglobin levels, oxygenation status and hypotension. In that context, it is reassuring to note that recent systematic reviews that included >25 case reports and a few retrospective studies in newborn infants found topical NTG to be safe and effective in relieving arterial spasm and local ischaemia after peripheral arterial cannulation 19 20…”