Myocardial infarction in a neonate

Summary

Due to the lack of evidence-based guidelines, management strategies for neonatal MI should be individualized and administered largely at the discretion of responsible treating teams. Supportive care with a focus on preserving adequate circulation and antithrombotic therapy with a view to restoring vascular patency are the mainstays of treatment. Thrombolytic therapy of neonatal MI includes a chance to completely restore myocardial function. Understanding the resilience of the neonatal heart and mechanism of cardiac cell repair in neonates may spark novel treatment strategies for severe MI in the large number of affected individuals in an aging population.

Zusammenfassung

Für die Behandlung des Herzinfarkts beim Neugeborenen gibt es keine auf Evidenz beruhende Empfehlung. Die Behandlung muss individuell gestaltet werden und obliegt weitestgehend dem jeweiligen Behandlungs- team. Die Behandlung besteht aus supportiven Maßnahmen und antithrombotischen Medikamenten mit dem Ziel der Wiedereröffnung verschlossener Gefäße. Eine Thrombolyse mit Alteplase birgt beim Neugeborenen die Chance einer vollständigen Erholung der Herzfunktion. Das bessere Verständnis der außerordentlichen Widerstandsfähigkeit und Regenerationskraft des Herzes von Neugeborenen kann zur Entwicklung neuer Behandlungsstrategien des Herzinfarkts in einer alternden Gesellschaft beitragen.

Keywords

infant - newborn - myocardial infarction - thrombolytic therapy - tissue plasminogen activator

Schlüsselwörter

Neugeborenes - Kind - Herzinfarkt - Thrombolyse - Alteplase

• References

• 1 Rosendaal FR. Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. Thromb Haemost 1997; 78 (01) 1-6.
• 2 Haubner BJ, Schneider J, Schweigmann U. et al. Functional Recovery of a Human Neonatal Heart After Severe Myocardial Infarction. Circ Res 2016; 118 (02) 216-221.
• 3 Andrew M, Paes B, Johnston M. Development of the hemostatic system in the neonate and young infant. Am J Pediatr Hematol Oncol 1990; 12 (01) 95-104.
• 4 Andrew M, Paes B, Milner R. et al. Development of the human coagulation system in the full-term infant. Blood 1987; 70 (01) 165-172.
• 5 Parmar N, Albisetti M, Berry LR, Chan AK. The fibrinolytic system in newborns and children. Clin Lab 2006; 52 (3–4|): 115-124.
• 6 Will A. Neonatal haemostasis and the management of neonatal thrombosis. Br J Haematol 2015; 169 (03) 324-332.
• 7 Ignjatovic V, Pelkmans L, Kelchtermans H. et al. Differences in the mechanism of blood clot formation and nanostructure in infants and children compared with adults. Thromb Res 2015; 136 (06) 1303-1309.
• 8 van Elteren HA, Veldt HS, Te Pas AB. et al. Management and outcome in 32 neonates with thrombotic events. Int J Pediatr 2011; 2011: 217564.
• 9 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics 1995; 96 (5 Pt 1|): 939-943.
• 10 Monagle P, Chan AK, Goldenberg NA. et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl|): e737S-e801S.
• 11 Albisetti M. Thrombolytic therapy in children. Thromb Res 2006; 118 (01) 95-105.
• 12 Manco-Johnson MJ, Grabowski EF, Hellgreen M. et al. Recommendations for tPA thrombolysis in children. On behalf of the Scientific Subcommittee on Perinatal and Pediatric Thrombosis of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis. Thromb Haemost 2002; 88 (01) 157-158.
• 13 Zenz W, Arlt F, Sodia S, Berghold A. Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years. Semin Thromb Hemost 1997; 23 (03) 321-332.
• 14 Nowak-Gottl U, von Kries R, Gobel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed 1997; 76 (03) F163-F167.
• 15 Deutsch MA, Cleuziou J, Noebauer C. et al. Successful management of neonatal myocardial infarction with ECMO and intracoronary r-tPA lysis. Congenit Heart Dis 2014; 09 (05) E169-E174.
• 16 Williams MD. Thrombolysis in children. Br J Haematol 2010; 148 (01) 26-36.
• 17 Ade-Ajayi N, Hall NJ, Liesner R. et al. Acute neonatal arterial occlusion: is thrombolysis safe and effective?. J Pediatr Surg 2008; 43 (10) 1827-1832.
• 18 Foglia MJ, Poss KD. Building and re-building the heart by cardiomyocyte proliferation. Development 2016; 143 (05) 729-740.
• 19 Simpson DL, Mishra R, Sharma S. et al. A strong regenerative ability of cardiac stem cells derived from neonatal hearts. Circulation 2012; 126 (11 Suppl 1|): S46-S53.
• 20 Hallbergson A, Gillespie MJ, Dori Y. A case of neonatal myocardial infarction: left coronary artery thrombus resolution and normalisation of ventricular function by intracoronary low-dose tissue plasminogen activator. Cardiol Young 2015; 25 (04) 810-812.
• 21 Cesna S, Eicken A, Juenger H, Hess J. Successful treatment of a newborn with acute myocardial infarction on the first day of life. Pediatr Cardiol 2013; 34 (08) 1868-1870.
• 22 Murugan SJ, Gnanapragasam J, Vettukattil J. Acute myocardial infarction in the neonatal period. Cardiol Young 2002; 12 (04) 411-413.