Neonatal Compartment Syndrome and Compound Presentation at Birth

Abstract

Neonatal compartment syndrome is a rare condition. Early diagnosis and timely surgical intervention are paramount to optimize outcome. Time to fasciotomy is the most important prognostic factor. The purposes of this study were to describe a case presentation of neonatal compartment syndrome associated with a compound birth presentation and to perform a literature review. In this case, the neonate's fingers were noted to be present on maternal cervical examination 24 hours before delivery. The patient then was noted to have a sentinel skin lesion. A diagnosis of neonatal compartment syndrome was suspected, and she underwent urgent fasciotomy. Literature review identified a total of 60 patients from 26 studies. Most patients were managed operatively. All patients presented with a sentinel skin lesion, emphasizing the importance of this clinical sign in diagnosis. Manometry is not routinely performed and no standards are available for acceptable pressure gradients.

Keywords: Fasciotomy; Manometry; Neonatal compartment syndrome; Sentinel skin lesion.

Figure 1

Preoperative images. A Sentinel skin lesions noted at 2.5 hours of life. B X-ray of upper arm with no acute abnormalities. C Progression of skin lesions at 4.5 hours of life.

Figure 2

Postoperative images. A On postoperative day (POD) 1, duskiness of the muscles was noted. B By POD 4, there was development of superficial necrosis that was allowed to demarcate. C On POD 14, the patient again presented with superficial cellulitis of the dorsal hand and a small dorsal abscess positive for methicillin-sensitive Staphylococcus aureus. D Two months after surgery, the patient’s wound had fully healed with improving mild contracture of the volar wrist.