Ref Number = PITIKA-ASPR0242
Shella, Kamilah Haniyah Munawar, Ketut Indriani
Objective: Postnatal limb ischemia is a rare and dangerous phenomenon in neonate. It can occur mostly of iatrogenic origin. Umbilical catheterization is medical procedure that is often performed in neonate and one of its complication is limb ischemia. Management options of limb ischaemia include nitroglycerin ointment, anticoagulation, thrombolysis and surgery.
Case Illustration: A 2000-g female neonate was born by spontaneous delivery at 32 weeks gestasional age. Apgar scores 6 at 1 minute and 9 at 5 minutes. She developed respiratory distress. We used CPAP to provided respiratory support, inserted an UVC, then admitted to NICU. After 10th days of admission, neonatal hyperbilirubinemia and sepsis was found. Later on, there was discoloration of the right foot, so UVC removed and changed with peripheral vein infusion on the left leg. The discoloration resolved after a day, but was followed by gangrene of distal phalanges of 1-3-4 right toes. We had examined the right lower limb by Doppler ultrasound, the result was stenosis suspected at the level of right posterior tibial artery. We considered for using anticoagulant, but that was not provided in our hospital. The only vasodilator agent that available was cilostazol. We commenced a 25 mg of cilostazol that given twice a day for nine days. On the 25th days of gangrene treatment, slight improvement in color and perfusion was noted. The recovery was good but the distal phalange of 3rd right toe were lost.
Conclusion: Extreme caution should be given to prevent the complication of umbilical catheterization. Even cilostazol as vasodilator gives satisfactory result in this case but further study is still needed. There is no evidence based medicine about effectiveness  of cilostazol in low birth weight infant. 
Keywords: limb ischaemic, umbilical catheter
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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