Use of Topical Nitroglycerine in the Neonatal Population Following Peripheral Tissue Ischaemia: Case Report and Updates about Safety Concerns

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Very Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Very Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Very Good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion establishes that limb ischaemia, distal to the umbilical arterial line insertion is rare and the possible cause could be a migrating thrombus from the umbilical arterial line. The Discussion highlights that limb ischaemia in this case was not associated with peripheral arterial cannulation or pricking which makes the case different from all previous reports. Relevant literature has been cited to support the Discussion. The study concludes that its findings have shown that it is possible to successfully treat premature infant with finger ischaemia using topical nitroglycerine. The findings of the study add to the existing knowledge of efficacy and safety of the drug and it can be used as an alternative for those who do not respond to the existing treatment.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Writing style

Q: Is it clear and understandable?

A: Good

Further comments on the paper

Comments: The case report presents the rare case of finger ischaemia of an extremely preterm female infant who was treated successfully with topical nitroglycerine. The study highlights the potential benefits of the drug in neonates and its findings add to the previous reports of the drug’s efficacy and safety. 30 days post treatment with topical nitroglycerine the patient’s fingers had attained full perfusion and the nail beds were intact except for the ring finger. The findings of the study show the possibility of occurrence of thrombotic occlusion distal from the line insertion. The study concludes that for premature and term infants, who do not respond to standard measures or in whom anticoagulation may increase the risk of bleeding, topical nitroglycerine may be a useful initial therapy for the reversal of tissue ischaemia. Further studies are needed to determine the dose and the frequency of administration and optimum time for initiating nitroglycerine treatment after the ischaemic event. Future studies involving randomized controlled trial are needed to investigate the drug’s use as a solo therapy or in combination with anticoagulation.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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