Digital Ischemia in an Extreme Preterm Infant Treated with Nitroglycerin Patch

A report described a case of a baby girl born at 24 weeks gestation experiencing numerous prematurity sequelae like respiratory distress syndrome and grade 2 intraventricular hemorrhage (IVH). She received an umbilical venous catheter at birth for venous access and total parenteral nutrition. Still, no umbilical arterial catheter or arterial cannulation was attempted, particularly in the affected arm/hand. 

On 6th day of her life, she developed gradual mild bluish discoloration on the second, third, and fourth fingers of her right hand, which worsened after initial management. 

The urgent Doppler showed a mild reduction in blood flow in the radial and ulnar arteries of the affected hand. The patient received a nitroglycerin patch placed over the affected hand fingers. Her 4 cm2 strip was replaced every 12 hours for five days and was continuously monitored.

Within a few hours of applying the topical nitroglycerine patch, the patient's condition improved gradually, and the ischemic changes markedly improved over the next 5–7 days, which completely resolved four weeks later.

Al Qurashi M, Al-Khotani A, Mohtisham F, et al. Digital Ischemia in an Extreme Preterm Infant Treated with Nitroglycerin Patch. Case Reports in Pediatrics. 2024; 2024. https://doi.org/10.1155/2024/2255756