Use of topical nitroglycerin in newborns with ischaemic injuries after vascular cannulation

Hoyo, P. Vivar del; Ruiz, Prado Sánchez; Río, Mercedes Ludeña del; Oliva, Jesús Cecilio López-Menchero; Cabezas, Miguel Ángel García

doi:10.1016/j.anpede.2016.01.006

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Surmising that the risk of amputation is higher when the tissue ischemia is more extensive and the degree of necrosis is more severe, additional treatment besides local application of nitroglycerin ointment may be needed in patients with serious symptoms. All the studies described above reported that the application of nitroglycerin medication was followed by improvements in peripheral arterial ischemia and circulation of areas with necrosis, restoration of skin color, and recovery of the skin, except in areas of partial loss [2,5,[8][9][10][11]13,14].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Need For Studymentioning

confidence: 99%

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

Kim¹,

Lee²,

Kim³

2020

Child Health Nurs Res

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Purpose: The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin.Methods: In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x2 test, t-test, Mann-Whitney U test, logistic regression.Results: Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x2=35.97, p<.001), lower birth weight (x2=29.40, p<.001), lower blood pressure (x2=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage.Conclusion: Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.

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Section: Discussionmentioning

confidence: 99%

Section: Need For Studymentioning

confidence: 99%

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

Kim¹,

Lee²,

Kim³

2020

Child Health Nurs Res

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Topical nitroglycerin in newborns with ischemic injuries: A systematic review

Mosalli

Khayyat

Qarni

et al. 2021

Saudi Pharmaceutical Journal

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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.

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Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review

Huang

Wan

et al. 2020

WJCC

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BACKGROUND Extremely premature infants have poor vascular conditions. Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters, and these vessels are often accompanied by arteries; thus, it is easy to mistakenly enter the artery. CASE SUMMARY The case of an extremely premature infant (born at gestational age 28 +3 ) in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported. On the 19 th day of hospitalization, the index finger, middle finger and ring finger of the left hand were rosy, the left radial artery and brachial artery pulse were palpable, the recovery was 95%, and the improvement was obvious. At discharge 42 d after admission, there was no abnormality in fingertip activity during the follow-up period. CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2% nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb. Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.

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Use of topical nitroglycerin in newborns with ischaemic injuries after vascular cannulation

Cited by 3 publications

References 4 publications

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

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

Topical nitroglycerin in newborns with ischemic injuries: A systematic review

Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review

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