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Use of Topical Nitroglycerin in the Treatment of Acute Limb Ischemia: Four-Year Experience in a Mixed Neonatal and Pediatric Intensive Care Unit Cover

Use of Topical Nitroglycerin in the Treatment of Acute Limb Ischemia: Four-Year Experience in a Mixed Neonatal and Pediatric Intensive Care Unit

Open Access
|Mar 2026

Figures & Tables

Figure 1.

Progression of the ALI lesion in case 7. Sequential images illustrate the evolution of ischemia and its sequelae: a) day 1, first signs of ischemia; b) day 1, 12 hours after onset; c) day 3; d) day 5, initiation of treatment; e) day 35; f) day 49; g) day 73; h) day 252.

PICU patients treated with nitroglycerin – demographic and comorbidity data_

No.Year of admissionSexAge, daysReason for PICU admissionIMV, daysInotropic support, daysRenal replacement therapySepsisLength of stay, days
1.2022M315 (10.5 months)Postoperative care (cardiac surgery)177NN+
2.2022M505 (16.8 months)Postoperative care (cardiac surgery)3343HDF + peritoneal dialysis+41
3.2023F73 (2.4 months)Postoperative care (cardiac surgery)2825NN+62
4.2023F5692 (15,5years)Acute liver failure*4HDF+109
5.2024M106 (3.5 months)Postoperative care (craniosynostosis surgery)1-No AKI-3
6.2024M22 (0.7 months)Congenital heart disease with cardiogenic shock5323HDF+63
7.2024F244 (8.1 months)Bronchiolitis with ARDS186NN+31

PICU patients treated with nitroglycerin – ALI location, management and outcome_

No.ALI etiologyALI locationNG administrationNG startedTreatment duration, daysACTACT, daysABXMaximum MetHb value, %Outcome
1.PHExtremities of all four limbs (hands and feet)NG patches of 5 mg every 48 hoursD6LMWH+0.4Stopped ischemia progression (child died of non-ALI related complications)
2.ACRight hand fingersNG ointment 4 mg/g every 24 hoursD012NFH → LMWH28+1.2Stopped ischemia progression. Partial recovery, partial amputation of 4th finger
3.PHFingers of both feetNG ointment 4 mg/g every 24 hoursD19LMWH28+1.6Full recovery
4.PHBoth legs, up to the kneesNG ointment 4 mg/g every 24 hoursD53NFH → LMWH89+1.9No recovery, early amputation due to infectious gangrene
5.ACRight handNG ointment 4 mg/g every 12 hoursD12LMWH89-1.2Full recovery
6.ACLeft leg, up to the kneeNG ointment 4 mg/g every 12 hoursD017LMWH7+1.8Full recovery
7.AC1st to 4th right hand fingersNG ointment 4 mg/g every 12 hoursD520NFH → LMWH79+1.4Stopped ischemia progression. Partial recovery, partial amputation of 1st finger
DOI: https://doi.org/10.34763/jmotherandchild.20263001.d-25-00039 | Journal eISSN: 2719-535X | Journal ISSN: 2719-6488
Language: English
Page range: 49 - 57
Submitted on: Oct 15, 2025
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Accepted on: Dec 5, 2025
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Published on: Mar 6, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2026 Ana Rita Jesus, Ana Rita Fradique, Catarina Teixeira, Leonor Carvalho, Teresa Dionísio, published by Institute of Mother and Child
This work is licensed under the Creative Commons Attribution 4.0 License.