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Tourniquet-like forces associated with baby carrier purpura

Tourniquet-like forces from baby carriers resulted in petechiae and purpura of the lower extremities of healthy infants, which could be caused by the Rumpel-Leede phenomenon, according to study results recently published in JAMA Dermatology.

Researchers studied three otherwise healthy infants who developed acute-onset localized petechiae and purpura of the lower extremities following recent exposure to baby carriers.

The index patient was an infant boy who had been taken on a 2-hour hike by his father using a “legs out” forward facing baby carrier. The cloth material of the baby carrier was noted to have clinched tight around the infant’s lower extremities at the conclusion of the hike.

Petechiae and purpura were observed on the infant’s legs almost immediately after release of tension of the cloth material. There were normal pulses and no edema, and the lesions spontaneously resolved over several days.

There were two subsequent cases of healthy-appearing infants who presented with petechiae and purpura of the lower extremities following recent exposure to baby carriers. One patient had mildly elevated levels of aspartate transaminase (AST), alanine transaminase, platelets and creatine kinase, and the other infant had mild elevated AST value. No underlying bleeding diathesis was revealed in laboratory investigations in consultation with a hematology service. Lesions resolved within several weeks.

The three infants remained healthy during follow-up.

While life-threatening conditions are associated with acute-onset petechiae and purpura, Rumpel-Leede phenomenon, a clinical finding characterized by acute dermal capillary rupture caused by tourniquet-like forces, could be a more benign cause, the researchers wrote.

“Excessively tight baby carriers may induce a Rumpel-Leede phenomenon in susceptible infants,” the researchers wrote. “Certain viral infections causing thrombocytopenia, including Epstein-Barr virus, may help lower the threshold for occurrence; notably, two patients in this series had mild transaminits, suggesting a predisposing viral cause.”

“Given the ubiquity of baby carriers in today’s society, it is unclear why more cases of this phenomenon have yet to be documented,” the researchers concluded. “Similar presentations may simply be unrecognized, and factors such as duration of exposure, carrier type, infant positioning and local terrain may play roles. Larger, prospective studies would also help elucidate the utility of “muscle markers” (eg, AST and creatine kinase) as potential screening tools.”– by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.