Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report

Sarah Gil; Kamela Loo; Indira Chandrasekar

doi:doi:10.11648/j.ajp.20220804.25

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Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report

Sarah Gil, Kamela Loo, Indira Chandrasekar

Published in American Journal of Pediatrics (Volume 8, Issue 4)

Received: 17 November 2022 Accepted: 8 December 2022 Published: 27 December 2022

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Abstract

Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.

Published in	American Journal of Pediatrics (Volume 8, Issue 4)
DOI	10.11648/j.ajp.20220804.25
Page(s)	276-279
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Extremely Low Birth Weight Infants, Umbilical Arterial Catheters, Peripheral Ischemia, Methemoglobinemia, Peri-Viable Infants, Intraventricular Hemorrhage

References

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APA Style

Sarah Gil, Kamela Loo, Indira Chandrasekar. (2022). Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. American Journal of Pediatrics, 8(4), 276-279. https://doi.org/10.11648/j.ajp.20220804.25

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ACS Style

Sarah Gil; Kamela Loo; Indira Chandrasekar. Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. Am. J. Pediatr. 2022, 8(4), 276-279. doi: 10.11648/j.ajp.20220804.25

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AMA Style

Sarah Gil, Kamela Loo, Indira Chandrasekar. Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. Am J Pediatr. 2022;8(4):276-279. doi: 10.11648/j.ajp.20220804.25

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@article{10.11648/j.ajp.20220804.25,
  author = {Sarah Gil and Kamela Loo and Indira Chandrasekar},
  title = {Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {8},
  number = {4},
  pages = {276-279},
  doi = {10.11648/j.ajp.20220804.25},
  url = {https://doi.org/10.11648/j.ajp.20220804.25},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220804.25},
  abstract = {Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.},
 year = {2022}
}

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TY  - JOUR
T1  - Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report
AU  - Sarah Gil
AU  - Kamela Loo
AU  - Indira Chandrasekar
Y1  - 2022/12/27
PY  - 2022
N1  - https://doi.org/10.11648/j.ajp.20220804.25
DO  - 10.11648/j.ajp.20220804.25
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 276
EP  - 279
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20220804.25
AB  - Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.
VL  - 8
IS  - 4
ER  -

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Author Information

Sarah Gil

Department of Neonatology, Valley Children’s Health Care, Madera, United States
Kamela Loo

Department of Neonatology, Valley Children’s Health Care, Madera, United States
Indira Chandrasekar

Department of Neonatology, Valley Children’s Health Care, Madera, United States

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APA Style

Sarah Gil, Kamela Loo, Indira Chandrasekar. (2022). Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. American Journal of Pediatrics, 8(4), 276-279. https://doi.org/10.11648/j.ajp.20220804.25

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ACS Style

Sarah Gil; Kamela Loo; Indira Chandrasekar. Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. Am. J. Pediatr. 2022, 8(4), 276-279. doi: 10.11648/j.ajp.20220804.25

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AMA Style

Sarah Gil, Kamela Loo, Indira Chandrasekar. Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report. Am J Pediatr. 2022;8(4):276-279. doi: 10.11648/j.ajp.20220804.25

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@article{10.11648/j.ajp.20220804.25,
  author = {Sarah Gil and Kamela Loo and Indira Chandrasekar},
  title = {Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {8},
  number = {4},
  pages = {276-279},
  doi = {10.11648/j.ajp.20220804.25},
  url = {https://doi.org/10.11648/j.ajp.20220804.25},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220804.25},
  abstract = {Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.},
 year = {2022}
}

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TY  - JOUR
T1  - Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report
AU  - Sarah Gil
AU  - Kamela Loo
AU  - Indira Chandrasekar
Y1  - 2022/12/27
PY  - 2022
N1  - https://doi.org/10.11648/j.ajp.20220804.25
DO  - 10.11648/j.ajp.20220804.25
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 276
EP  - 279
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20220804.25
AB  - Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.
VL  - 8
IS  - 4
ER  -

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