Axillary Artery Thrombosis in a NeonateIn Utero: A Case Report

Abstract

We describe a neonate of 38-week and 6-day gestation born by lower uterine cesarean section for breech presentation, where it was evident on delivery that there was significant edema of the right arm from the deltoid to the distal tips of the fingers. Doppler flow ultrasound revealed extensive arterial thromboembolus. Intravenous heparin was prescribed for three days at a dose of 27.5 U/kg/h, targeting an activated partial thromboplastin time (APTT) of 60–75 seconds, followed by a course of subcutaneous enoxaparin at a dose of 1.8 mg/kg and then 2 mg/kg twice daily, titrated to a factor Xa level of 0.5–1.0 U/mL for another three days. Significant clinical improvement occurred and the child was eventually, discharged on subcutaneous enoxaparin. Magnetic resonance imaging showed multiple intracranial abnormalities. At five months increased upper limb tone, brisk reflexes, and small head circumference were noted. At one year, increased tone and increased paucity of movement on the right side persisted, and some speech delay and visual inattention were noted. Recent follow-up at 16.5 months of age demonstrated a right sided hemiplegia with increased tone and brisk reflexes. We describe the case in detail and review current knowledge regarding the management of arterial thrombosis in the neonate.

Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

“…It is not clear whether her events were related to COVID-19 infection in pregnancy, but the association is not excluded. Arterial thrombosis affecting a limb in a neonate in utero has previously been reported, with definitive identification of the thrombus [8] and it occurred several years prior to COVID-19.…”

Consequences of Transplacental Transmission of the SARS-CoV-2 Virus: A Single-Center Experience

“…They believed that the embolus originated in the placenta and later passed through the umbilical vein, then traveled through the liver and the lower caval vein to the right and left heart chamber, and then continued on the path to the right axillary artery and carotid. However, there were no signs of abnormalities in the umbilical cord [ 24 ]. From the abovementioned data on the impact of SARS-CoV-2 infection on the hypercoagulable condition, we can assume that the acute ischemia of the extremities in one of our cases can be explained in this way.…”

Spontaneous axillary arterial thrombus in a newborn

“…Neonatal arterial thrombi are rare and iatrogenic in most cases, due to indwelling arterial lines. To date, there have been several reports of spontaneous arterial thrombi in the brain 1,2 and extremities 1–5 at birth. Although brain thrombosis can be detected by the onset of neurological symptoms, such as seizure, detecting thrombosis in the extremities is difficult because there are fewer symptoms, which may be overlooked.…”