Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review
BackgroundOxidized heme iron forms methemoglobin (MeHb), impairing the oxygen-binding capability of hemoglobin molecules. Nitric oxide (NO) obtained from glyceryl trinitrate (GTN) patches can cause MeHb formation during limb ischemia topical treatment. This case reports a preterm infant treated with...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1505233/full |
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| author | Andrea Calandrino Andrea Calandrino Francesco Vinci Francesco Vinci Marcella Battaglini Marcella Battaglini Samuele Caruggi Samuele Caruggi Chiara Andreato Chiara Andreato Carolina Montobbio Marianna Vannati Diego Minghetti Giorgia Brigati Luca Antonio Ramenghi Luca Antonio Ramenghi |
| author_facet | Andrea Calandrino Andrea Calandrino Francesco Vinci Francesco Vinci Marcella Battaglini Marcella Battaglini Samuele Caruggi Samuele Caruggi Chiara Andreato Chiara Andreato Carolina Montobbio Marianna Vannati Diego Minghetti Giorgia Brigati Luca Antonio Ramenghi Luca Antonio Ramenghi |
| author_sort | Andrea Calandrino |
| collection | DOAJ |
| description | BackgroundOxidized heme iron forms methemoglobin (MeHb), impairing the oxygen-binding capability of hemoglobin molecules. Nitric oxide (NO) obtained from glyceryl trinitrate (GTN) patches can cause MeHb formation during limb ischemia topical treatment. This case reports a preterm infant treated with multiple GTN patches who developed elevated MeHb levels, a potential therapy complication.Case presentationA preterm female newborn (25 + 4 weeks, 560 g) was delivered by cesarean due to maternal HELLP syndrome and intubated for respiratory distress. After developing ischemia in her right hand and foot, GTN patches were applied, but therapy caused a peak in methemoglobin (MeHb) levels, prompting patch removal. MeHb levels normalized after 18 h, and after adjusting therapy, ischemia resolved successfully.DiscussionWe report the case of a premature IUGR infant who developed elevated methaemoglobin (MeHb) levels during topical GTN therapy for catheter-related extremity ischemia. While GTN is effective for neonatal ischemia, its dosing, and safety lack consistent guidelines. Elevated MeHb levels, noted in similar cases here reviewed, can impair oxygen exchange, especially in vulnerable preterm infants with immature skin and reduced enzyme activity.ConclusionThis case highlights the need for careful MeHb monitoring and a multidisciplinary approach to manage ischemia safely in neonates undergoing GTN therapy. |
| format | Article |
| id | doaj-art-6eb28b32a2de4a75a1d7a86309ee9d01 |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-6eb28b32a2de4a75a1d7a86309ee9d012025-02-12T07:25:54ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-02-011310.3389/fped.2025.15052331505233Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature reviewAndrea Calandrino0Andrea Calandrino1Francesco Vinci2Francesco Vinci3Marcella Battaglini4Marcella Battaglini5Samuele Caruggi6Samuele Caruggi7Chiara Andreato8Chiara Andreato9Carolina Montobbio10Marianna Vannati11Diego Minghetti12Giorgia Brigati13Luca Antonio Ramenghi14Luca Antonio Ramenghi15Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, ItalyNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, ItalyBackgroundOxidized heme iron forms methemoglobin (MeHb), impairing the oxygen-binding capability of hemoglobin molecules. Nitric oxide (NO) obtained from glyceryl trinitrate (GTN) patches can cause MeHb formation during limb ischemia topical treatment. This case reports a preterm infant treated with multiple GTN patches who developed elevated MeHb levels, a potential therapy complication.Case presentationA preterm female newborn (25 + 4 weeks, 560 g) was delivered by cesarean due to maternal HELLP syndrome and intubated for respiratory distress. After developing ischemia in her right hand and foot, GTN patches were applied, but therapy caused a peak in methemoglobin (MeHb) levels, prompting patch removal. MeHb levels normalized after 18 h, and after adjusting therapy, ischemia resolved successfully.DiscussionWe report the case of a premature IUGR infant who developed elevated methaemoglobin (MeHb) levels during topical GTN therapy for catheter-related extremity ischemia. While GTN is effective for neonatal ischemia, its dosing, and safety lack consistent guidelines. Elevated MeHb levels, noted in similar cases here reviewed, can impair oxygen exchange, especially in vulnerable preterm infants with immature skin and reduced enzyme activity.ConclusionThis case highlights the need for careful MeHb monitoring and a multidisciplinary approach to manage ischemia safely in neonates undergoing GTN therapy.https://www.frontiersin.org/articles/10.3389/fped.2025.1505233/fullneonatesprematuritymethemoglobinemianigroglycerineischemia |
| spellingShingle | Andrea Calandrino Andrea Calandrino Francesco Vinci Francesco Vinci Marcella Battaglini Marcella Battaglini Samuele Caruggi Samuele Caruggi Chiara Andreato Chiara Andreato Carolina Montobbio Marianna Vannati Diego Minghetti Giorgia Brigati Luca Antonio Ramenghi Luca Antonio Ramenghi Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review Frontiers in Pediatrics neonates prematurity methemoglobinemia nigroglycerine ischemia |
| title | Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review |
| title_full | Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review |
| title_fullStr | Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review |
| title_full_unstemmed | Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review |
| title_short | Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review |
| title_sort | increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants a case report and literature review |
| topic | neonates prematurity methemoglobinemia nigroglycerine ischemia |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1505233/full |
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