VASCULAR SPASM
- Blanching or cyanosis of extremity following insertion or manipulation of peripheral or umbilical arterial catheter (UAC)
- Remove catheter unless absolutely essential
- Elicit reflex vasodilation
- reflex vasospasm on insertion of UAC can occasionally be corrected by reflex vasodilation by warming
contralateral limb
- reflex vasospasm on insertion of UAC can occasionally be corrected by reflex vasodilation by warming
- Volume expansion
- if appropriate, give sodium chloride 0.9% 10 mL/kg as volume expander
- GTN patch
- use can be considered to improve perfusion but not trialled or licensed for use in babies. Discuss with
consultant
- use can be considered to improve perfusion but not trialled or licensed for use in babies. Discuss with
- Liaise with plastic surgeons, haematologists and other specialists as needed
VASCULAR THROMBOSIS
Clinical features suggesting vascular thrombosis
Site:
Clinical signs
- Pallor
- Cold arm/foot
- Weak or absent peripheral pulse
- Discolouration
- Gangrene
- Difficulty establishing a proper pulse oximetry trace
- Delayed capillary refill time on affected limb
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Systemic hypertension
- Haematuria
- Oliguria
- Renal failure
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Flank mass
- Haematuria
- Hypertension
- Thrombocytopenia
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Cool lower limbs
- Cyanosis
- Oedema
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Swelling of the upper limbs and head
- Chylothorax
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- High pressures on long line
- SVC obstruction
- Chylothorax
- Swelling
- Discolouration of extremity
Diagnostic imaging
- Doppler scan for large vessel thrombus (sensitivity and specificity uncertain in the neonatal period)
- Real-time 2-dimensional ultrasound
- CT scan with contrast
- Contrast angiography (at specialised centre)
Clinical signs
- Heart failure
- Embolic phenomenon
Diagnostic imaging
- Echo
Clinical signs
- Respiratory failure
Diagnostic imaging
- Lung perfusion scan (at specialised centre)
MANAGEMENT OF THROMBOEMBOLISM
- Controversial
- Inadequate controlled trials
- Inform consultant
- Liaise with plastic surgeons, haematologists and other specialists as required
Treatment options
Conservative
- Observe closely with no intervention e.g. unilateral renal vein thrombosis
Anticoagulation and thrombolysis
- No controlled neonatal trials
- Use only under guidance from haematologist and/or plastic surgeon
Date updated: