Neonatal gangrene of the extremities

Vascular insufficiency of a peripheral limb is a well-recognized and serious complication occurring in newborn infants. A 15-year review of a Level III neonatal intensive care unit at The Children's Hospital of Eastern Ontario revealed 10 infants who had a vascular insult to a limb necessitating the amputation of a portion of the limb. Predisposing factors to vascular occlusion were prematurity, polycythemia, umbilical artery catheterization, and intensive care treatment for other life-threatening illnesses. The lower extremity was most commonly affected, requiring below-knee amputations in two infants, knee disarticulation in one, and toe amputations in five. The remaining infants required an elbow disarticulation and amputation of the fingers, and one child had a massive ischemic contracture of the lower limb. Care should be taken not to amputate prematurely and await definitive demarcation of the gangrenous portion. Amputation should be designed to preserve growth plates wherever possible to ensure an adequate stump for prosthetic fitting in the older child.