[abstract] HBO2T for acute limb ischemia in neonates and infants

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[abstract] HBO2T for acute limb ischemia in neonates and infants

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Title: [abstract] HBO2T for acute limb ischemia in neonates and infants
Author: Uner, A; Chin, WG; Sprau, SE
Abstract: Introduction: Acute limb ischemia in neonates and infants caused by arterial catheterization-induced thromboembolism (ACITE) is catastrophic. We present three cases treated with hyperbaric oxygen therapy (HBO2T) for ACITE. Background: Neonates and infants are often too small for surgical therapy. HBO2T can be offered with anticoagulation and supportive therapy if any arterial flow is left. Materials and methods: Case series. All HBO2Ts were USN TT9 at 2.21 ATA. Results/Conclusion: Case 1: A 1.6-kg premature male with hypoplastic right ventricle, pulmonary atresia, PDA-dependent right-to-left shunt, and poor prognosis of survival. Right-leg ischemia caused by ACITE age 15 days. HBO2T started within 24 hours and performed with heparin, PGE iv drip and cardiology consultation. Right-leg cyanosis improved immediately. Worsening hypoxia occurred after four HBO2Ts. The child succumbed to PDA closure at 30 days of age. Case 2: A 1.5-kg premature male with mesoblastic nephroma, resected on Day 5. Cyanotic right leg caused by ACITE noted postoperatively. Intraventricular hemorrhage forbade anticoagulation. 11 daily HBO2Ts performed starting postop Day 1. Cyanosis improved, toes 1 and 5 autoamputated. Surgical amputation was averted. Child doing well at 15 months, with some residual foot contracture. Case 3: A 6-month-old girl with methymalonic acidemia, suffered right cyanotic leg caused by ACITE. Treated with tPA and heparin. Daily HBO2T started four days later. At depth during fourth treatment, episode of ALOC and bradycardia, responded to BVM and CPR. Further HBO2T stopped by PICU. No evidence of PTX or AGE. Symes foot amputation one month later for refractory foot gangrene. Conclusions: 1. HBO2T can reverse limb hypoxia caused by acute thrombosis in neonates and infants. 2. Risks vs benefits should be considered in newborns with PDA-dependent cyanotic heart disease as there is no established safe dose of oxygen. 3. Clinical outcomes are influenced by prematurity, comorbidities, and delays in HBO2T consultation.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/10035
Date: 2011

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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