Evidence map›Paper›PMID 40013111›Full record

ArticleFrontiers in pediatrics2025

Increase in methemoglobin fraction due to the use of glyceryl trinitrate patches in preterm infants: a case report and literature review.

Andrea Calandrino, Francesco Vinci, Marcella Battaglini, Samuele Caruggi, Chiara Andreato, Carolina Montobbio, Marianna Vannati, Diego Minghetti, Giorgia Brigati, Luca Antonio Ramenghi

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Frontiers in pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Andrea CalandrinoDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.
Francesco VinciDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.
Marcella BattagliniDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.
Samuele CaruggiDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.
Chiara AndreatoDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.
Carolina MontobbioNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Marianna VannatiNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Diego MinghettiNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Giorgia BrigatiNeonatal Intensive Care Unit, Department of Maternal and Neonatal Health, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Luca Antonio RamenghiDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Mother and Child Health, School of Medical and Pharmaceuticals, University of Genoa, Genoa, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Oxidized heme iron forms methemoglobin (MeHb), impairing the oxygen-binding capability of hemoglobin molecules. Nitric oxide (NO) obtained from glyceryl trinitrate (GTN) patches can cause MeHb formation during limb ischemia topical treatment. This case reports a preterm infant treated with multiple GTN patches who developed elevated MeHb levels, a potential therapy complication. Case presentation: A preterm female newborn (25 + 4 weeks, 560 g) was delivered by cesarean due to maternal HELLP syndrome and intubated for respiratory distress. After developing ischemia in her right hand and foot, GTN patches were applied, but therapy caused a peak in methemoglobin (MeHb) levels, prompting patch removal. MeHb levels normalized after 18 h, and after adjusting therapy, ischemia resolved successfully. Discussion: We report the case of a premature IUGR infant who developed elevated methaemoglobin (MeHb) levels during topical GTN therapy for catheter-related extremity ischemia. While GTN is effective for neonatal ischemia, its dosing, and safety lack consistent guidelines. Elevated MeHb levels, noted in similar cases here reviewed, can impair oxygen exchange, especially in vulnerable preterm infants with immature skin and reduced enzyme activity. Conclusion: This case highlights the need for careful MeHb monitoring and a multidisciplinary approach to manage ischemia safely in neonates undergoing GTN therapy.

Indexed as

ischemiamethemoglobinemianeonatesnigroglycerineprematurity

Identifiers

PMID40013111
PMCPMC11860868

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.