NEONATAL GANGRENE OF THE EXTREMITIES

Vascular insufficiency of a peripheral limb is a well-recognized and s erious complication occurring in newborn infants. A 15-year review of a Level III neonatal intensive care unit at The Children's Hospital of Eastern Ontario revealed 10 infants who had a vascular insult to a li mb necessitating the amputation of a portion of the limb. Predisposing factors to vascular occlusion were prematurity, polycythemia, umbilic al artery catheterization, and intensive care treatment for other life -threatening illnesses. The lower extremity was most commonly affected , requiring below-knee amputations in two infants, knee disarticulatio n in one, and toe amputations in five. The remaining infants required an elbow disarticulation and amputation of the fingers, and one child had a massive ischemic contracture of the lower limb. Care should be t aken not to amputate prematurely and await definitive demarcation of t he gangrenous portion. Amputation should be designed to preserve growt h plates wherever possible to ensure an adequate stump for prosthetic fitting in the older child.