Child Health Nursing Research

Korean Academy of Child Health Nursing (한국아동간호학회)
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Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

  • Kim, Jeongeun (Neonatal Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Jin Won (Neonatal Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Dong Yeon (Hematology Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2020.09.06
  • Accepted : 2020.09.30
  • Published : 2020.10.31
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Abstract

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 χ2 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 (χ2=35.97, p<.001), lower birth weight (χ2=29.40, p<.001), lower blood pressure (χ2=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.

Keywords

References

  1. Troiani S, Cardona A, Milioni M, Monacelli D, Verrotti A, Gehring M, et al. Evidence of impaired microvascular dilatation in preterms with acute respiratory distress syndrome. International Journal of Cardiology. 2017;241:83-86. https://doi.org/10.1016/j.ijcard.2017.04.018
  2. Kamar R, van Vonderen JJ, Lopriore E, Te Pas AB. Nitroglycerin for severe ischaemic injury after peripheral arterial line in a preterm infant. Acta Paediatrica. 2013;102(4):e144-e145. https://doi.org/10.1111/apa.12141
  3. Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: Physiology, development, and care. Clinics in Dermatology. 2015; 33(3):271-280. https://doi.org/10.1016/j.clindermatol.2014.12.003
  4. Oranges T, Dini V, Romanelli M. Skin physiology of the neonate and infant: Clinical implications. Advances in Wound Care. 2015; 4(10):587-595. https://doi.org/10.1089/wound.2015.0642
  5. Mosalli R, Elbaz M, Paes B. Topical nitroglycerine for neonatal arterial associated peripheral ischemia following cannulation: A case report and comprehensive literature review. Case Report in Pediatrics. 2013;2013:608516. https://doi.org/10.1155/2013/608516
  6. Saracco P, Bagna R, Gentilomo C, Magarotto M, Viano A, Magnetti F, et al. Clinical data of neonatal systemic thrombosis. Journal of Pediatrics. 2016;171:60-66. https://doi.org/10.1016/j.jpeds.2015.12.035
  7. Piersigilli F, Bersani I, Giliberti P, Ronchetti MP, Mancinelli RL, Cavadenti I, et al. Neonatal limb ischemia: Caudal blockade and NIRS monitoring. European Journal of Pediatrics. 2014;173(12): 1599-1601. https://doi.org/10.1007/s00431-013-2152-y
  8. Samiee-Zafarghandy S, van den Anker JN, Ben Fadel N. Topical nitroglycerin in neonates with tissue injury: A case report and review of the literature. Paediatrics and Child Health. 2014;19(1):9-12. https://doi.org/10.1093/pch/19.1.9
  9. Han YS, Song S, Sung TJ, Chun J. Successful management of severe peripheral tissue ischemia after arterial catheterization in micro preemies using humidification and topical nitroglycerin. Neonatal Medicine. 2017;24(4):197-201. https://doi.org/10.5385/nm.2017.24.4.197
  10. Kleydman K, Cohen JL, Marmur E. Nitroglycerin: A review of its use in the treatment of vascular occlusion after soft tissue augmentation. Dermatologic Surgery. 2012;38(12):1889-1897. https://doi.org/10.1111/dsu.12001
  11. Geffroy-Perrin C, Geffroy C, Gentili ME. Application of nitroglycerin patch to treat finger cyanosis due to unintentional injection of epinephrine. The American Journal of Emergency Medicine. 2017;35 (2):372.e5-372.e6. https://doi.org/10.1016/j.ajem.2016.07.051
  12. Gomella TL, Cunningham MD, Eyal FG, Zenk KE. Neonatology: Management, procedures, on-call problems, diseases, and drugs. 7th ed. New York: McGraw-Hill Medical; 2013. p. 89-97, 537-546.
  13. Vivar del Hoyo P, Sanchez Ruiz P, Ludena del Rio M, Lopez-Menchero Oliva JC, Garcia Cabezas MA. Use of topical nitroglycerin in newborns with ischaemic injuries after vascular cannulation. Anales de Pediatría (English Edition). 2016;85(3):155-156. https://doi.org/10.1016/j.anpede.2016.01.006
  14. Colmenero CG, Garcia EM, Morente GB, Sanchez JT. Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: A new therapeutic option. Dermatologic Therapy. 2014;27(5):278-280. https://doi.org/10.1111/dth.12137
  15. Sung SI, Ahn SY, Seo HJ, Yoo HS, Han YM, Lee MS, et al. Insensible water loss during the first week of life of extremely low birth weight infants less than 25 gestational weeks under high humidification. Neonatal Medicine. 2013;20(1):51-57. https://doi.org/10.5385/nm.2013.20.1.51
  16. Tonnus W, Meyer C, Paliege A, Belavgeni A, von Massenhausen A, Bornstein SR, et al. The pathological features of regulated necrosis. The Journal of Pathology. 2019;247(5):697-707. https://doi.org/10.1002/path.5248
  17. Albahrani Y, Hunt R. Newborn skin care. Pediatrics Annals. 2019;48 (1):e11-e15. https://doi.org/10.3928/19382359-20181211-01
  18. Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: Diagnosis, management and outcome. Pediatric Nephrology. 2012;27 (1):17-32. https://doi.org/10.1007/s00467-010-1755-z
  19. Mourot JM, Oliveira HM, Woodson LC, Herndon DN, Chung DH. Complications of femoral artery catheterization in pediatric burn patients. Journal of Burn Care and Research. 2009;30(3):432-436. https://doi.org/10.1097/BCR.0b013e3181a28c6e
  20. Teo MC, Shah VA. Digital ischaemia following inadvertent arterial cannulation of a peripherally inserted central catheter in a very low birth weight infant. Singapore Medical Journal. 2015;56(8):482-483. https://doi.org/10.11622/smedj.2015125
  21. Rizzi M, Goldenberg N, Bonduel M, Revel-Vilk S, Amankwah E, Albisetti M. Catheter-related arterial thrombosis in neonates and children: A systematic review. Thrombosis and Haemostasis. 2018; 118(6):1058-1066. https://doi.org/10.1055/s-0038-1642635
  22. Saxonhouse MA. Management of neonatal thrombosis. Clinics in Perinatology. 2012;39(1):191-208. https://doi.org/10.1016/j.clp.2011.12.018
  23. Kwon JW, Hong MK, Park BY. Risk factors of vasopressor-induced symmetrical peripheral gangrene. Annals of Plastic Surgery. 2018; 80(6):622-627. https://doi.org/10.1097/sap.0000000000001314
  24. Dong J, Zhang L, Rao G, Zhao X. Complicating symmetric peripheral gangrene after dopamine therapy to patients with septic shock. Journal of Forensic Sciences. 2015;60(6):1644-1646. https://doi.org/10.1111/1556-4029.12844
  25. Kumar J, Dutta S, Sundaram V, Saini SS, Sharma RR, Varma N. Platelet transfusion for PDA closure in preterm infants: A randomized controlled trial. Pediatrics. 2019;143(5):e20182565. https://doi.org/10.1542/peds.2018-2565
  26. Pacifici GM. Clinical pharmacology of dobutamine and dopamine in preterm neonates. Medical Express. 2014;1(5):275-283. https://doi.org/10.5935/MedicalExpress.2014.05.12
  27. Bhat BV, Plakkal N. Management of shock in neonates. The Indian Journal of Pediatrics. 2015;82(10):923-929. https://doi.org/10.1007/s12098-015-1758-7
  28. Arnaiz-Garcia ME, Arnaiz-Garcia AM, Gutierrez-Diez JF, Gonzalez-Santos JM, Garcia-Martin A, Alonso-Pena D, et al. Vasopressor-induced peripheral skin necrosis after shock. Revista Portuguesa de Cardiologia (English Edition). 2017;36(7-8):573-574. https://doi.org/10.1016/j.repce.2016.07.010
  29. Eley KA, Young JD, Watt-Smith SR. Epinephrine, norepinephrine, dobutamine, and dopexamine effects on free flap skin blood flow. Plastic and Reconstructive Surgery. 2012;130(3):564-570. https://doi.org/10.1097/PRS.0b013e31825dbf73
  30. Onalo R, Ogala WN, Lawal YZ, Chom ND, Odogu O, Ige SO. Congenital gangrene of the extremities in a newborn. Nigerian Journal of Clinical Practice. 2011;14(2):245-248. https://doi.org/10.4103/1119-3077.84031