Neonatal Arterial Thrombosis at Birth: Case Report and Literature Review

Abstract

Neonatal thromboembolism is rare and in most cases iatrogenic from indwelling central catheters, peripheral arterial lines, and umbilical lines. It often requires urgent intervention to restore perfusion and to avoid morbidity and even mortality. Very few case reports of neonatal arterial thrombosis at birth are described in the literature. We present the case of a full-term infant noted to have marked left arm swelling at birth. Doppler ultrasound of the arm demonstrated a large thrombus in the left subclavian, axillary, and brachial arteries. He underwent left arm fasciotomy and anticoagulant therapy with good recovery. We present this case with a brief review of the literature.

Antithrombotic Therapy in Neonates and Children

“…327 Tarry et al 328 identifi ed 44 cases of peripheral arterial TEs secondary to catheterizations or arterial punctures in children with nephrotic syndrome. Friedman et al 309 reported the use of microvascular surgery in a heterogeneous group of neonates with vascular injury.…”

Pulmonary Artery Thrombus Presenting as Cyanotic Cardiac Defect in a Neonate

“…The prevalence of symptomatic neonatal arterial thrombosis is approximately 1 in 40,000 births, with 90% of cases linked to indwelling intra-arterial catheters (1)(2)(3). Other risk factors are sepsis, polycythemia, maternal diabetes, asphyxia, and inherited thrombophilias (1)(2)(3).…”

“…Other risk factors are sepsis, polycythemia, maternal diabetes, asphyxia, and inherited thrombophilias (1)(2)(3). Neonate presenting with isolated pulmonary artery thrombosis with severe pulmonary arterial hypertension is a rare event (4).…”

Intrauterine Upper Extremity Thrombosis Successfully Treated with Recombinant Tissue Plasminogen Activator, Enoxaparin and Collagenase

“…The clinical presentation varies depending on the extremity involved and the initial timing of thrombosis [1,2]. Several case reports on extremity hypoperfusion and gangrene due to intrauterine thrombosis at birth can be found in the literature [1,2,3,4,5,6,7,8,9,10]. Although the condition is usually associated with a poor prognosis, favorable outcomes have also been reported [3,4] (table 1).…”