Introduction Neonatal aortic thromboses represent rare, yet serious conditions commonly associated
with severe morbidity and a high mortality rate [1]
[2]. Their management, however, issues major challenges due to limited experience and
lacking treatment recommendations [2]
[3]. Although systemic thrombolysis is considered first-line treatment in case of organ-threatening
ischemia, a limited number of attempted thrombolytic treatment approaches, particularly
in preterm neonates, have been reported to this day [2]
[5]
[6]
[8].
Method We report a case of successful thrombolysis in a preterm newborn presenting with
acute Leriche syndrome caused by spontaneous aortic thrombosis.
Results A preterm newborn of 35 weeks gestational age presented with signs of severe symmetric
lower limb ischemia with cyanosis, reduced oxygen saturation and undetectable blood
pressure in both lower limbs at first examination. An immediately performed echocardiogram
showed no evidence of intracardiac thrombosis, congenital heart defects or aortic
anomalies, while a thrombotic occlusion with absence of arterial blood flow in the
aortic bifurcation and both iliac arteries was detected via Doppler ultrasound. After
interdisciplinary discussion, systemic thrombolysis with tissue plasminogen activator
(rtPA) at a dose of 0.05 mg/kg/h was started after application of a bolus of 0.1 mg/kg
body weight, and was later on increased up to 0.075 mg/kg/h. An incremental dissolution
of thrombosis and restoration of blood flow in sequentially performed ultrasound examinations
could be observed. Parallel to thrombolysis, fresh frozen plasma was administered
to raise plasminogen levels. Systemic thrombolysis with rtPA was ended after 48 hours
with overlapping continuation of anticoagulation therapy with subcutaneously applied
low molecular weight heparin (anti-Xa activity 0.6 – 1 IU/ml). No hemorrhagic complications
have been observed. Laboratory screening showed no indication for acquired or hereditary
thrombophilia. The patient was discharged at the twelfth day of life in good clinical
condition without residual symptoms, while a follow-up examination two months after
discharge showed a sufficient lower limb perfusion despite the presence of a persistent
residual thrombus.
Conclusion Spontaneous neonatal aortic thromboses in absence of umbilical artery catheterization,
aortic anomalies or prothrombotic disorders represent a rare and potentially life-threatening
condition [2]
[6]
[7]. Particularly in preterm newborns, thrombolytic therapy may be complicated due to
limited experience and both lacking dose recommendations and reliable laboratory monitoring
options of thrombolytic activity [2]
[4]
[7]. Our case underlines the successful use of thrombolysis in preterm infants under
careful risk-benefit consideration. Although several case reports outline the feasibility
of thrombolysis in these patients, further studies are required to confirm the efficacy
and safety of systemic thrombolysis in neonatal aortic thrombosis [5]
[6]
[7]
[8].
