Arterial Thrombosis in Utero Causing Arm Gangrene in the Infant of a Diabetic Mother

Gangrene of a limb presenting at birth is rare and has heterogenous etiology. Approximately 25% of the cases have been reported to occur in infants of diabetic mothers (IDMs). We report a newborn IDM with brachial artery thrombosis in utero and neonatal gangrene which necessitated a below elbow amputation at 5th day of life. The diagnosis of external left brachial artery thrombosis was made by Doppler sonography flow studies and was confirmed at autopsy. Despite the use of anticoagulants, the gangrene advanced and amputation of the necrotic forearm was performed. The postoperative period was complicated by mesenteric artery thrombosis with subsequent necrotizing enterocolitis, convulsions, septicemia and death. The reason for the increased tendency to develop thrombi in IDMs has not been elucidated. Changes in coagulation factors have been reported in newborn IDMs with poor control of maternal diabetes. Increased clotting and decreased fibrinolysis found in diabetics may lead to arterial thrombosis in IDMs in utero and postnatally. Use of anticoagulants in at-risk infants should be considered early to prevent further thrombosis and ischemic complications postnatally.