Table 1.
Neonatal peripheral ischemia: cause, location and course of treatment with topical nitroglycerine (n = 76).
| Author/Year | GA (weeks) Weight (g) |
Cause of ischemia | Location of ischemia | Time† (hours) |
2% TNG form, dose | Treatment course |
|---|---|---|---|---|---|---|
| O’Reilly et al., 1988 | ND | Extravasation | Dorsum of the foot | 2.5 | Patches, 25 mg | One dose |
| Denkler and Cohen, 1989 | 34 (1814) | Extravasation | Left hand to low forearm, left foot to knee | Hand: 9.5 Foot: 4 |
Ointment, 13.8 mm/kg | Two doses |
| Wong et al., 1992 | 24 (7 8 0) | PAC | Right hand | 3 | Ointment, 4 mm/kg | 12 h |
| 25 (7 0 0) | PAC | Right hand | 2 | Ointment, 4 mm/kg | 3 h | |
| 26 (6 7 0) | Extravasation | Anterior forearm, and the medial aspect of the arm | 0.5 | Ointment, 4 mm/kg | 24 h | |
| 31 (1565) | Extravasation | Arm, left upper-lateral area of the chest around the anterior axillary | 1.5 | Ointment, 4 mm/kg | 2 h | |
| Varughese, 2001 | 33 (1870) | UAC | Right hip gluteal region | 4 | Patches, 0.4 mg | 30 h |
| Baserga et al., 2002 | 23 (6 6 0) | PAC | Left hand fingers | 1 | Ointment, 4 mm/kg | 30 min |
| 25 (ND) | UAC | Right leg | 1.5 | Ointment, 4 mm/kg | 45 min | |
| 30 (1620) | UAC | Left leg | 1 | Ointment, 4 mm/kg | 30–45 min | |
| Vasquez et al., 2003 | 26 (8 9 6) | PAC | Left hand mid-palm to fingertips | 7 | Ointment, 4 mm/kg | 27 days |
| Maffei et al., 2006 | 29 (8 9 5) | CVC | Left arm | 0.5 | Patches 11 mm/kg |
7 days |
| 32 (2250) | PAC | Right hand | 1.1 | Patches 4 mm/kg |
4 days | |
| Ancora et al., 2006 | 28 (8 8 0) | UVC | Fingers of the right hand and of the feet | 7 | Patches/ Ointment | 5/ 11 days |
| Mousavi et al., 2010 | 32 (1650) | UVC | Right leg and foot | ND | Ointment, 4 mm/kg |
ND |
| Akingbola et al., 2012 | 31 (3600) | PAC | Left lower limb, foot | ND | Ointment, 4 mm/kg | 21 days |
| Kamar et al., 2013 | 25 (5 0 0) | 2 PAC | Left hand, foot | 24 | Spray | 7 days |
| Mosalli et al., 2013 | 25 (5 2 0) | PAC | Middle, ring and index fingers of right hand | 8 | Ointment, >4 mm/kg | 21 days |
| Samiee-Zafarghandy et al., 2014 | 26 (ND) | PVC | Toes, sole, dorsum and ankle of the left foot | 6 days | Ointment, 4 mm/kg | 14 days |
| Teo and Shah, 2015 | 32 (9 7 0) | PAC | Dorsum of the hand | 24 | Patches | 7 days |
| Dilli et al., 2015 | 28 (1000) | UAC | Bilateral lower limb | ND | Ointment, 4 mm/kg | 15 days |
| Parra et al., 2016 | 32 (ND) | Thrombin injection PSA | Right arm | ND | ND | ND |
| ‡Yong et al., 2016 | 28–31 (ND) | UAC | ND | ND | Patch | ND |
| Vivar del Hoyo et al., 2016 | 24 (ND) | UVC, UAC | Left three toes | ND | Ointment, 4 mm/kg | 5–18 days |
| 35 (ND) | PICC, PVC | Fingers | ND | Ointment, 4 mm/kg | 5–18 days | |
| ND§ | PICC, PVC | Fingers | ND | Ointment, 4 mm/kg | 5–18 days | |
| ND§ | PICC, PVC | Fingers | ND | Ointment, 4 mm/kg | 5–18 days | |
| Han et al., 2017 | 24 (7 6 0) | PAC | Five fingers and palm of left hand | 72 | 0.2% glyceryl trinitrate ointment | 29 days |
| Isık et al., 2017 | 34 (2190) | PVC + phenytoin | Right hand | ND | ND | ND |
| Kuttysankaran et al., (2018) | ND§ (3150) | Femoral artery | Left leg | ND | Cream ND | ND |
| Mintoft et al., 2018 | 24 (6 5 0) | PAC | Lower limbs, the thumb and forefinger of the hand | ND | Patches, 18.7 | 2 days |
| 24 (6 1 7) | PAC | Toes on the right foot | Immediate | Patches, 18.7 | 5 days | |
| Weerasekera et al., 2019 | 26 (8 8 0) | PAC | Fingertips of small, middle, ring and index fingers | ND | Ointment, 4 mm/kg | 14 days |
| Zarkesh, 2020 | 37 (2775) | PVC | 4 Fingers | Minutes | Ointment | One hour |
| *Kim et al., 2020 | ≤ 29 - ≥33 (<1000 - >1800) | UAC, UVC, PICC, CVC | ND | 0.03–10.5 days | Patch | 0.03–10.5 days |
| Lavie-Nevo et al., 2020 | 26 (5 6 0) | PAC | Left arm | Several hours | 2% ointment | 5 days |
| Mosalli, 2021 | 25 (7 7 5) | PVC | Right hand | ND | Spray 0.4 mg | 28 days |
†Time of TNG application after ischemic changes appeared.
Term infant but gestation in weeks not reported.
‡Five cases that were all treated with a patch with resolution in only one infant.
*Thirty-six cases were reported in this series. The mean ± standard deviation of TNG application in those with (n = 2) and without necrosis (n = 34) was 10.50 ± 14.85 and 0.03 ± 0.17 days respectively.
CVC; Central venous catheter, GA; gestational age, ND; Not Documented, PA; pseudoaneurysm, PAC; Peripheral arterial catheter, PICC; Peripherally inserted venous catheter, PVC; Peripheral venous catheter, UAC; Umbilical arterial catheter, UVC; Umbilical venous catheter.