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Published on: December 31, 2015
Intrinsic neonatal limb ischaemia: A systematic review
Aayushi Singal1, Yangmyung Ma1, Manwi Singh1
1Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, UK.
Insights
This review analyzed intrinsic neonatal limb ischaemia (INLI) in newborns. Medical management showed higher positive outcomes, but no causative factors were identified for INLI.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Vascular Biology
Background:
- Intrinsic neonatal limb ischaemia (INLI) is a critical condition affecting newborns.
- Understanding its causes and effective management is crucial for improving outcomes.
Purpose of the Study:
- To systematically review factors associated with INLI.
- To analyze the causes and management strategies for INLI.
- To propose a classification system for guiding INLI treatment.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
- Analysis of 115 identified articles related to INLI.
- Categorization of clinical manifestations for management guidance.
Main Results:
- Most INLI cases at birth involved the upper limb (72%).
- Thrombus was the most frequent cause of INLI (66%).
- Medical management alone was associated with higher positive outcomes, potentially due to milder cases.
Conclusions:
- No specific causative factors for INLI development were identified.
- Management strategies should be tailored based on the timing of the in-utero insult and tissue damage.
- A proposed four-grade classification system aims to guide clinical management of INLI.
Abstract:
This systematic review aimed to analyse the factors associated with intrinsic neonatal limb ischaemia (INLI), its causes and its management. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, and 115 articles were identified for analysis. For INLI detected at birth, most newborns presented with upper limb ischaemia (72%), with thrombus being the most common cause (66%). Higher rates of positive outcomes were observed when INLI was treated with medical management alone, although this could reflect a less severe manifestation. The data did not demonstrate any causative factors for the development of INLI. Depending on the timing of the in-utero insult and the degree of tissue involvement and loss, different primary interventions may be selected for management. A classification system is proposed to help guide the choice of management, in which the different clinical manifestations of INLI are divided into four grades.
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