Page 39 - Virtual Vascular Vol 13

Acute digital or limb gangrene in the newborn is very rare. The fact that the fingers and toes
are well-formed indicate that the ischaemic events occurred relatively late in gestation. The

limb buds of an embryo develop at the first trimester, but the digits (fingers and toes) are
fused and webbed at week 6 in utero. Not until week 10 in utero will the fingers and toes
become distinct and have nails.

As to the aetiology, neonatal digital gangrene may be due to infection, drugs (e.g. inotropes),
vascular malformation, haematological pro-thrombotic or vasculitic syndromes. It is also

associated with maternal anti-phospholipid syndrome.

Treatment is medical and close observation and monitoring. There are no bypass or

endovascular treatment possible. The mainstay of t management is with keeping warm,
avoidance of vasopressors and inotropes, use of topical or systemic vasodilators, and
anticoagulation (e.g. heparin). Treatment should be multi-disciplinary involving
paediatricians, haematologists, vascular specialists, rheumatologists and immunologists.

Some patients may require long-term anticoagulation or immunosuppression.

Above all, the parents and the child should have good social and psychological support,

because the loss of digits in a child is a very traumatic experience to the family. 39