Intrinsic neonatal limb ischaemia: A systematic review.

Abstract

This systematic review aimed to analyse the factors associated with intrinsic neonatal limb ischaemia (INLI), its causes and its management. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, and 115 articles were identified for analysis. For INLI detected at birth, most newborns presented with upper limb ischaemia (72%), with thrombus being the most common cause (66%). Higher rates of positive outcomes were observed when INLI was treated with medical management alone, although this could reflect a less severe manifestation. The data did not demonstrate any causative factors for the development of INLI. Depending on the timing of the in-utero insult and the degree of tissue involvement and loss, different primary interventions may be selected for management. A classification system is proposed to help guide the choice of management, in which the different clinical manifestations of INLI are divided into four grades.