812 - Pentoxifylline in the Treatment of Peripheral Tissue Ischemia in Preterm Neonates: a New Adjuvant Therapy

Publication Number: 812.6207

Wu-Shiun Hsieh, Department of Pediatrics Cathay General Hospital and Department of Pediatrics National Taiwan University College of Medicine, Taipei, Taiwan, Taipei City, Taipei, Taiwan (Republic of China); Wei-Chin Wang, Cathay General Hospital, Taipei, Taipei, Taiwan (Republic of China); Yi-Li Hung, Cathay General Hospital, Taipei, Taipei, Taiwan (Republic of China); Chung-Min Shen, Cathay General Hospital, Taipei, Taipei, Taiwan (Republic of China)

Background: Neonatal vascular vasospasm or thrombotic disease resulting in limb ischemia is common and usually occurs after intravascular catheter insertion. Current treatment for neonatal peripheral tissue ischemia includes the removal of intravascular catheters, application of a warm pack to the opposite limb, and topical pharmacological therapy, but still has a limited effect. Pentoxifylline (PTX) exhibits anti-inflammatory properties by inhibiting erythrocyte phosphodiesterase, lowering blood viscosity, and improving microcirculation and tissue perfusion, and has been used for peripheral circulatory disorders in adults; however, few studies have applied it to neonatal limb ischemia.

Objective: Here, we present three preterm neonates with peripheral limb vascular thrombosis who were successfully treated with PTX without adverse effects.

Design/Methods: Retrospective chart reviews were conducted for peripheral tissue ischemia treated with oral PTX between 2015 and 2021 in the Cathay General Hospital NICU. The perinatal characteristics, clinical presentations, dosage, and treatment duration of PTX were collected.

Results: Three preterm neonates (F:M=1:2) with gestational ages of 26, 26, and 29 weeks and birth weight of 770 g, 907 g and 1,702 g, respectively, were enrolled. Presentation of circulatory disturbance over the distal upper limbs, including pallor, coldness, and discoloration, followed by gangrene change, developed after arterial catheter placement in two cases, each occurring on days of life 9 and 13. The other case with gangrene changes over the left second to fourth fingers and left first to third toes was noticed 2 h after birth, without arterial catheter insertion over the distal limbs. Vascular catheter removal and contralateral limb heat packing was performed immediately in all cases. One patient received enoxaparin treatment, whereas the others received topical sildenafil applied to the gangrene-change region. Because of the unsatisfactory condition, oral PTX (20 mg/kg/day) divided into three doses was administered. After PTX treatment, the ischemic lesions improved within one week, with no significant adverse effects, such as bleeding, thrombocytopenia, and intraventricular or retinal hemorrhage.

Conclusion(s): PTX may be a safe and effective adjuvant therapy for neonatal peripheral tissue ischemia. Further randomized controlled trials are needed to assess the efficacy and long-term adverse effects of PTX in preterm neonates.

Gangrene changes over fingers before and after pentoxifylline treatment


Gangrene changes over fingers before and after pentoxifylline treatment