Prof of pediatrics - haematology / oncology Zagazig University -pediatrics department-haematology/onology unit Zagazig, Ash Sharqiyah, Egypt
Background: Management of neonatal gangrene is usually conservative,
Aims: To report controversy of the fate of neonatal gangrene &its management .In this paper,a newborn with reversible toes gangrene is reported without any triggering factor and cured before started with anticoagulants therapy.
Methods: Full term male newborn was admitted to neonatal intensive care at birth, was noted to have bluish discoloration of left second toe .The distal pulsations were felt equally on both lower limbs. The general condition and vital signs of the baby within normal. No signs of sepsis, organomegaly, or a history of umbilical catheter .Purpuric eruption was found all over the body. We considered all the differential diagnosis in the investigations .Urgent Doppler ultra sound was done to save the baby toes. laboratory investigations (CBC, sepsis workup, Coagulation profile ,Ddimer ,Protein S , proteinC). The mother was 28 years old neither diabetic or hypertensive. No history autoimmune diseases or blood or coagulopathy disorders,no history of previous abortion or still birth .Mother s CBC before delivery was completely normal . she suffered from postpartum hemorrhage that need frequent blood transfusion. Informed assent was obtained
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Results: .Normal Duplex of both lower limb arterial &venous system no evidence of significant stenosis or occlusion Or DVT .Also free cranio ultrasonography CBC:revealed Anemia/Hb;11.6g/dl,thrombocytopenia:20,oo0/ul Normal coagulation profile, D-dimer 5.2Ug/ml. The infant was transfused by platelets as life saving and gamma globulin 1g/kg .. The surprising response within two days by gradual fading of the gangrene and continuous rising of the platelets number. Thrombophilia gene screening revealed that the patient has heterozygous mutation of MTHFR C6771,A1298C.now the patient start prophylaxis anticoagulant therapy .Free protein S&C assay is 45% &21 %
Conclusion(s): . Sometime decisions in critical situations are needed . Gangrene may be reversible in neonatal intensive care unit .
