Frostbite in Children: A Case Series and Development of a New Iloprost-Driven Protocol

Introduction: Frostbite in children is uncommon; however, when severe, it can be associated with amputation of digits. Frostbite protocols have been established for adults but not for children. This project outlines our experience with the use of a newly developed iloprost-driven protocol for managing frostbite in children. Methods: Motivated by a severe case of frostbite in a teenager, resulting in amputations of multiple digits, the adult Yukon Frostbite Protocol was modified for use in children. Key elements of the new Frostbite Management in Children Protocol include rewarming, iloprost infusion, alteplase administration, and hyperbaric oxygen therapy, if required. Frostbite severity is categorized according to the Cauchy grading system which in turn dictates specific treatment. A review of 3 subsequent cases treated using the protocol was performed. Outcomes recorded included digital amputation rate, motor/sensory recovery, and adverse effects of treatment. Results: In December 2022 to March 2024, 3 patients met the criteria for treatment with iloprost under the new protocol: a 9-year-old female with grade 3 frostbite; a 15-year-old male with grade 2 frostbite; and a 16-year-old male with grade 2 frostbite. There were no amputations. All 3 patients recovered motor and sensory function, though one patient experienced significant hypersensitivity. There were no adverse effects from the treatment protocol, and it was well accepted by nursing and medical staff. Conclusion: An iloprost-based protocol has been developed for children with frostbite. The protocol was accepted by hospital staff and well tolerated by the patients.