Nitroglycerin Spray for Neonatal Peripheral Ischaemia: A Case Report and Review of the Literature

Abstract Peripheral ischaemia is a rare but serious complication of vascular cannulation in neonates, particularly in pre-term infants with fragile vasculature and limited collateral circulation. Early recognition and timely management are essential to prevent irreversible tissue injury. We report a pre-term male infant born at 33 weeks of gestation who developed acute cyanosis of the fingers of the left hand shortly after peripheral intravenous cannulation. Immediate removal of the cannula and conservative measures were performed; however, ischaemic changes persisted. Nitroglycerin spray was administered at a dose of 800 μg every 6 h, resulting in noticeable improvement in perfusion within 24 h and complete resolution of ischaemia by day 7. No adverse effects were observed during treatment. This case adds to the limited available evidence, suggesting that nitroglycerin spray may be a safe and effective non-invasive rescue therapy for neonatal peripheral ischaemia when initial conservative measures fail. Further studies are needed to establish standardised dosing and confirm its safety and efficacy in neonates.