Digital Ischemia and Gangrene in Neonates and Preterm Infants: A Systematic Review

Abstract

Digital ischemia and gangrene in neonates and infants born preterm are rarely described, with evidence largely confined to case reports. Objective: To summarize reported clinical circumstances and distinguish preterm-specific observations from those involving term newborns. The review reported searching six information sources for publications from 2013 to 2023. The reported selection process identified 201 records, removed 27 duplicates, screened 174 records, assessed 85 full texts, and included five publications. We examined gestational age, age at presentation, anatomical site, clinical context, and outcomes. Two reports described extremely preterm neonates with catheter-associated ischemia, and one described a former preterm infant presenting later in infancy with sepsis-associated digital ischemia. Two additional reports involved term newborns, one with sepsis-associated digital gangrene and the other with dehydration, disseminated intravascular coagulation, and gangrene. The cases reflect heterogeneous clinical circumstances rather than a single established etiology. Causal inference and risk estimation are not possible from the available case-based evidence; incomplete historical search documentation further limits reproducibility.