Methemoglobinemia during the Use of Glyceryl Trinitrate Patches in Neonates: Two Case Reports

Alison Mintoft; Emma Williams; Christopher Harris; Nigel Kennea; Anne Greenough

doi:10.1055/s-0038-1669945

American Journal of Perinatology Reports, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e227-e229
DOI: 10.1055/s-0038-1669945

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Methemoglobinemia during the Use of Glyceryl Trinitrate Patches in Neonates: Two Case Reports

Alison Mintoft

¹Neonatal Intensive Care Centre, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

,

Emma Williams

²Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Christopher Harris

³MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom

⁴Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom

,

Nigel Kennea

⁵Neonatal Intensive Care Centre, St George's Hospital NHS Foundation Trust, London, United Kingdom

,

Anne Greenough

³MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom

⁴Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom

⁶NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom

› Institutsangaben

Abstract

Methemoglobinemia can result in severe hypoxia. It has been frequently reported during the use of inhaled nitric oxide, but can occur where nitrate containing medications are used. Glyceryl trinitrate (GTN) patches have been used in the treatment of digital and limb ischemia in prematurely born infants. Little is known about the pharmacokinetics of GTN when incorporated into patches. Studies of other topical forms of nitroglycerine have shown a wide range of absorption. It is likely that the increased permeability of the prematurely born infant's skin would facilitate absorption. We describe the use of GTN patches in two very prematurely born infants used to treat limb/digit ischemia. This resulted in methemoglobinemia and resultant increase in their supplementary oxygen requirements. Removal of the patches was associated with a reduction in their methemoglobin levels and the supplementary oxygen requirements back to baseline levels. In conclusion, routine monitoring of methemoglobin levels should be undertaken when GTN patches are used in very prematurely born infants.

Keywords

methemoglobinemia - preterm - glyceryl trinitrate - ischemia

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References
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