Spontaneous neonatal arterial thromboembolism

Abstract

Neonatal spontaneous arterial thromboembolism is a rare phenomenon with a high risk of morbidity and mortality. Currently, there is little information regarding common risk factors, diagnostic strategies, therapeutic interventions, and outcomes of this condition. The objective was to nucleate the best evidence regarding the disorder in order to facilitate early detection and treatment recommendations and document adverse outcomes. Web of Science, PubMed, Medline, CINAHL, Cochrane Databases, DARE, and OVID databases were searched using the following keywords: 'arterial' AND 'thrombus' OR 'thrombosis' OR 'thromboembolism' OR 'embolism' AND 'spontaneous' AND 'at birth' OR 'newborn' OR 'neonatal' OR 'fetal' AND 'umbilical cord' OR 'umbilical wall necrosis' AND 'coagulation abnormality' OR 'placenta bits' OR 'ischemic limbs'. The search yielded 172 articles, all of which were case series or single case descriptions. Twenty-seven met inclusion criteria, with a total of 53 newborns and 30 newborn pathology reports. Ultrasound was the preferred method of diagnosis and thromboembolic locations varied with the most common site being umbilical, resulting in embolism and vascular compromise. Treatment interventions and drug dosages were not standardized and ranged from use of anticoagulants to surgery and hyperbaric oxygen. The reported mortality rate was 32.8%. Recurring etiological features facilitated identification of possible sequences of events contributing to the disorder. The literature lacks empirical evidence to affirm causes and predisposing risk factors for timely diagnosis and effective treatment of spontaneous neonatal arterial thromboembolism. Further research is needed to clearly establish the causes and the efficacy of specific treatment options.

The Use of Low-Dose Recombinant Tissue Plasminogen Activator to Treat a Preterm Infant with an Intrauterine Spontaneous Arterial Thromboembolis

“…Most cases of thromboembolism during the neonatal period are due to vascular interventions; however, there have been very few reported cases of intrauterine spontaneous arterial thromboembolism in the literature [ 5 ]. Various risk factors, such as being an infant of a diabetic mother, having polycythemia, dehydration, sepsis, asphyxia, or oligohydroamnios, and being of the male gender can contribute to this condition, but the pathophysiology has not yet been fully clarified [ 1 , 6 ]. In the case of our patient, we observed cyanosis in the left forearm at birth.…”

“…Spontaneous arterial thromboembolisms are a serious cause of mortality and morbidity in the neonatal period, and the congenital, acquired, and inherited prothrombotic states of this condition along with maternal characteristics have been identified as significant risk factors. The hypofibrinolytic situation in neonates, especially in premature infants, includes hemodynamic changes during the transition from the fetal period to the neonatal period which may predispose infants to these types of thromboembolisms [ 1 ]. The goal of treatment is to prevent life-threatening situations that might occur because of the embolism and the recurrence of thrombosis while also minimizing the risk of bleeding.…”

Axillary Artery Thrombosis in a NeonateIn Utero: A Case Report

“…The Thrombosis and Hemostasis in Newborns (THiN) group does not include neuroimaging in their algorithm of non-CNS thrombosis [1], yet the underlying aetiological theory makes multiple emboli entirely plausible, and cerebral emboli may not be symptomatic. Hemiplegia is more common and more severe among children with MRI evidence of ischaemic stroke who do not present in the neonatal period [25, 26].…”

“…Neonatal arterial thrombosis is a serious condition resulting in high rates of morbidity and mortality [1]. The ability to form a blood clot in a controlled manner is essential; however, uncontrolled or excessive clotting may be life-threatening.…”

Neonatal Thromboembolic Events

“…Santral sinir sistemi bulgularının olduğu spontan arteriyel trombozda tanısal tetkik ve görüntüleme sonrasında emboli kaynağının saptanamadığı ilk atakta destek tedavisi uygulanması, emboli kaynağının saptandığı veya olayın tekrarladığı durumlarda AFH veya DMAH ile antikoagülan tedaviye başlanması önerilmektedir (16) . Santral sinir sistemi dışındaki arteriyel tromboz vakalarında görüntüleme ve kan tetkikleri sonrası, tıkanmaya neden olan trombozlarda antikoagülan tedavi, buna yanıt vermeyen olgularda trombolitik tedavi, kompartman sendromu ve/ veya gangren varlığında cerrahi ve gerekirse özel durumlarda hiperbarik oksijen tedavisi önerilir (16) .…”