Spontaneous aortic thrombosis in neonates: a case report and review of literature

Abstract

Neonatal aortic thrombosis is a rare occurrence but can be life-threatening. Most aortic thrombosis in neonates is related to umbilical artery catheters. A case of a neonate with a spontaneous aortic thrombosis is described here along with a comprehensive review of the literature for cases of neonatal aortic thrombosis not related to any intravascular device or procedure. The aetiologies of these spontaneous thromboses and the relevance of hypercoagulable disorders are discussed. The cases were analysed for odds of death by treatment method adjusted for era. The reference treatment method was thrombolysis and anticoagulation. No other treatment modality had significantly lower odds than the reference. Surgery alone had higher odds for death than the reference, but this may be confounded by severity of case. The management recommendations for clinicians encountering neonates with spontaneous neonatal aortic thrombosis are discussed.

Spontaneously Healed Arterial Thrombosis at Birth

“…1,4 For major arterial thromboses, initial management should consist in tissue plasminogen activator or thrombolytic therapy unless a contraindication exists. 1,4 For neonates with no response to initial unfractionated heparin therapy, thrombolysis should be considered. 1,4…”

“…1,4 For neonates with no response to initial unfractionated heparin therapy, thrombolysis should be considered. 1,4…”

“…Blood tests, including coagulation values and screening for thrombophilia, performed according to literature recommendations for neonatal thrombosis, resulted negative. 1 Due to a sudden and spontaneous resolution of the clinical picture, no therapy was needed, and the infant was discharged in good conditions, without any damage. No apparent cause was identified in the pathogenesis of the described neonatal thrombosis.…”

“…3 In terms of treatment, for minor arterial thromboses, supportive care and antihypertensives, as needed, are recommended. 1,4 Moderate arterial thromboses should be first treated with anticoagulation treatment with heparin in the absence of contraindications, such as active bleeding. 1,4 For major arterial thromboses, initial management should consist in tissue plasminogen activator or thrombolytic therapy unless a contraindication exists.…”

“…1,4 Moderate arterial thromboses should be first treated with anticoagulation treatment with heparin in the absence of contraindications, such as active bleeding. 1,4 For major arterial thromboses, initial management should consist in tissue plasminogen activator or thrombolytic therapy unless a contraindication exists. 1,4 For neonates with no response to initial unfractionated heparin therapy, thrombolysis should be considered.…”