Leg gangrene in a newborn

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A full-term, vaginally delivered, 7-day-old boy presented with poor feeding, tachypnea, and color change on his leg. His prenatal and family histories were unremarkable. Lethargy, decreased neonatal reflexes, respiratory distress, and a necrotic appearance on the distal left foot were observed. Left femoral pulse was absent. Laboratory examination revealed metabolic acidosis, hypernatremia, increased serum creatinine and acute phase reactants, and prolonged coagulation parameters. Doppler ultrasound and computerized tomographic angiography revealed decreased calibration in the left external iliac artery, monophasic weak blood flow in the superficial femoral and popliteal arteries, and absence of blood flow in the dorsalis pedis artery. Thrombophilia and congenital metabolic disorders were excluded. Low molecular weight heparin and antibiotic therapy led to resolution of the clinical picture except for his leg. Amputation below the knee was performed after demarcation of the gangrene became clear . He was discharged after an uneventful postoperative period.

A full-term, vaginally delivered, 7-day-old boy presented with poor feeding, tachypnea, and color change on his leg. His prenatal and family histories were unremarkable. Lethargy, decreased neonatal reflexes, respiratory distress, and a necrotic appearance on the distal left foot were observed (figure 1A). Left femoral pulse was absent. Laboratory examination revealed metabolic acidosis, hypernatremia, increased serum creatinine and acute phase reactants, and prolonged coagulation parameters. Doppler ultrasound and computerized tomographic angiography revealed decreased calibration in the left external iliac artery, monophasic weak blood flow in the superficial femoral and popliteal arteries, and absence of blood flow in the dorsalis pedis artery (figures 1B and 1C). Thrombophilia and congenital metabolic disorders were excluded. Low molecular weight heparin and antibiotic therapy led to resolution of the clinical picture except for his leg. Amputation below the knee was performed after demarcation of the gangrene became clear (figure 1D). He was discharged after an uneventful postoperative period.

Vascular insufficiency of the extremities, leading to ischemic necrosis of a limb, is a serious complication in newborns. Predisposing factors such as prematurity, polycythemia, maternal diabetes, and umbilical catheterization precipitate arterial thrombosis [1]. Sepsis and hypovolemia in addition to arterial malformation contributed to thrombosis and eventual gangrene in this patient. Amputation should be delayed until definite demarcation of the gangrenous portion is determined and growth plates should be preserved during amputation to ensure an adequate stump for subsequent prosthetic fitting [2].

References

1. Demirel NAydin MZenciroglu ABas AYYarali NOkumus N, et al. Neonatal thrombo-embolism: risk factors, clinical features and outcome. Ann Trop Paediatr 2009;29:271-9.

2. Letts MBlastorah Bal-Azzam S. Neonatal gangrene of the extremities. J Pediatr Orthop 1997;17:397-401.

Additional Info

  • Recieved: 11.04.2018
  • Accepted: 28.04.2018
  • Published Online: 29.04.2018
  • Printed: 01.09.2018
  • DOI: 10.4328/AEMED.133
  • Author: Soner Sertan Kara, Hasan Kahveci, Ali Fettah
  • Identifier: 10.4328/AEMED.133
  • How to Cite: Soner Sertan Kara, Hasan Kahveci, Ali Fettah. Leg gangrene in a newborn.
  • Running Title: Leg gangrene in a newborn
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