There are only a few cases of compartment in the neonate.
This can be a difficult diagnosis. Compartment syndrome in the neonate does not
present itself with the classic “P’s” as seen in adult patients. Compartment
syndrome in the neonate does not present itself with the classic “P’s” as seen
in adult patients. There are 5 P’s: pain/swelling, paresthesia, pulselessness,
pallor, and paralysis. Diagnosis in neonate is usually made retrospectively
after the patient has complications. The condition of compartment syndrome
usually occurs within the first 24 hours of birth. It usually occurs in the
forearm, is usually unilateral and occurs more in the dorsal aspect of the
forearm. Risk factors are the mother may be diabetic, some hypercoagulable
state (like polycythemia), and prematurity. The actual cause is not known,
however it can be a combination of extrinsic compression and hypercoagulable
state. Make sure to avoid missing the diagnosis of compartment syndrome. The
infant will have a swollen, tense forearm associated with skin lesions on the
forearm. The skin may have erythema, bullae, and edema. The skin lesions will
be present at birth and usually at the forearm. The patient may also have
pseudoparalysis, may lack spontaneous limb movement, and there might be some
nerve injury involved also. The clinical diagnosis of compartment syndrome will
be made after exclusion of other conditions such as infection, vascular injury,
and amniotic band syndrome. The clinical diagnosis of compartment syndrome will
be made after exclusion of other conditions such as infection, vascular injury,
and amniotic band syndrome. Infection could be cellulitis or can be necrotizing
fasciitis. Both should be excluded! Treatment of neonatal compartment syndrome
of the forearm should be early diagnosis and immediate fasciotomy. Ischemic
muscle contracture will develop from missing the diagnosis and delaying the
treatment.
