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Case Reports in Pediatrics
Volume 2013, Article ID 608516, 7 pages
Case Report

Topical Nitroglycerine for Neonatal Arterial Associated Peripheral Ischemia following Cannulation: A Case Report and Comprehensive Literature Review

1Department of Pediatrics, Umm Al Qura University, P.O. Box 7607, Mecca 21955, Saudi Arabia
2Department of Pediatrics, International Medical Center, Hael Street, P.O. Box 2172, Jeddah 21451, Saudi Arabia
3Department of Pediatrics (Neonatal Division), McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1

Received 30 July 2013; Accepted 8 September 2013

Academic Editors: R. Lauterbach, J. Muraskas, and K. Sarafidis

Copyright © 2013 Rafat Mosalli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Arterial cannulation in neonates is usually performed for frequent blood pressure monitoring and blood sampling. The procedure, while easily executed by skilled neonatal staff, can be associated with serious complications such as vasospasm, thrombosis, embolism, hematoma, infection, peripheral nerve damage, ischemia, and tissue necrosis. Several treatment options are available to reverse vascular induced ischemia and tissue damage. Applied interventions depend on the extent of tissue involvement and whether the condition is progressive and deemed life threatening. Standard, noninvasive measures include immediate catheter removal, limb elevation, and warming the contralateral extremity. Topical vasodilators, anticoagulation, thrombolysis, and surgery are considered secondary therapeutic strategies. A comprehensive literature search indicates that topical nitroglycerin has been utilized for the treatment of tissue ischemia in three preterms with umbilical arterial catheters and four with peripheral arterial lines. We report the first successful use of nitroglycerine ointment in a critically ill preterm infant with ischemic hand changes after brachial artery cannulation.