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Acute neonatal arterial occlusion: is thrombolysis safe and effective?

Ade-Ajayi, N; Hall, NJ; Liesner, R; Kiely, EM; Pierro, A; Roebuck, DJ; Drake, DP; (2008) Acute neonatal arterial occlusion: is thrombolysis safe and effective? J Pediatr Surg , 43 (10) pp. 1827-1832. 10.1016/j.jpedsurg.2008.04.025.

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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.

Type: Article
Title: Acute neonatal arterial occlusion: is thrombolysis safe and effective?
Location: United States
DOI: 10.1016/j.jpedsurg.2008.04.025
Keywords: Acute Disease, Amputation, Anticoagulants, Arterial Occlusive Diseases, Combined Modality Therapy, Female, Heparin, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Interdisciplinary Communication, Ischemia, Leg, Male, Massage, Plasma, Retrospective Studies, Risk Factors, Thrombectomy, Thrombolytic Therapy, Tissue Plasminogen Activator, Ultrasonography, Doppler
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Developmental Neurosciences Prog
URI: http://discovery.ucl.ac.uk/id/eprint/351604
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