Peripheral arterial occlusion in infants: a report of two cases treated conservatively

Occlusion of a major artery may occur in a newborn as a result of catheter placement, particularly an indwelling catheter, in the heart or umbilical artery. Primary occlusion of a major artery (unrelated to catheterization) is a rare occurrence. Two cases are presented describing arterial occlusion in male infants. In both cases the condition was diagnosed within days of birth, one baby had occlusion of the right femoral (thigh) artery, the other had occlusion of the left iliac artery (the groin area). Both infants were born at full term after uncomplicated pregnancies, and their mothers were in good health. In the first case, a slight decreased in the fetal heart rate was noted one week before birth. Soon after birth the infant appeared to have complete lack of blood flow to the left leg, which was cold and sensitive to touch. In the second case, the baby was observed to have a temporary loss of color in the right leg when he was four days old; this occurred with increasing frequency and by the seventh day he had no pulse in the right foot. In both cases Doppler studies (an ultrasound technique used to monitor blood flow) were used for diagnosis and monitoring; angiography (X-ray examination of the blood vessels following injection of radiopaque contrast dye) confirmed arterial occlusion and the success of treatment. Despite the usual recommendation that occlusion of a major artery be treated with emergency surgery, these infants were successfully treated medically by continuous infusion of urokinase (a thrombolytic agent) and verapamil (a vasodilator). In one case it was necessary to deliver the urokinase directly to the area of obstruction. Good blood supply to the leg was confirmed by Doppler. The causes of this condition are not clearly known. (Consumer Summary produced by Reliance Medical Information, Inc.)