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J Pediatr Surg. 2008 Oct;43(10):1827-32. doi: 10.1016/j.jpedsurg.2008.04.025.

Acute neonatal arterial occlusion: is thrombolysis safe and effective?

Author information

  • 1Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 3JH London, UK. adeajayi@doctors.org.uk

Abstract

PURPOSE:

We report our experience of the management of arterial occlusion in the newborn.

METHODS:

A case note review was carried out after ethical approval. Doppler ultrasonography confirmed the occlusion. Thrombolysis was the primary intervention. Surgery was used selectively. A good outcome was one without tissue loss or functional impairment or minimal tissue loss without functional impairment. Data are presented as medians with ranges.

RESULTS:

Ten patients (9 male; median gestational age, 35.5 weeks [range, 28-39 weeks]) presented on day 1 (range, 1-8 days). Initial management included systemic tissue plasminogen activator (8 patients) and surgery (2 infants in whom thrombolysis was contraindicated). Improvement was noted in 7 of 8 infants treated medically and in both who underwent surgery. Three infants had significant tissue loss. Outcome at 29 months (range, 1.3-95.4 months) was good in the remaining 7.

CONCLUSIONS:

A multidisciplinary approach, thrombolysis and selective surgery achieved tissue preservation and function in the majority while minimizing complications. Early referral to centers with multidisciplinary teams is recommended.

PMID:
18926215
[PubMed - indexed for MEDLINE]
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