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Am J Perinatol 2000; 17(3): 151-158
DOI: 10.1055/s-2000-9975
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

SEVERE AORTIC THROMBOSIS IN THE NEONATE-SUCCESSFUL TREATMENT WITH LOW-MOLECULAR-WEIGHT HEPARIN: TWO CASE REPORTS AND REVIEW OF THE LITERATURE

Gil Klinger1,3 , Jonathan Hellmann1,3 , Alan Daneman23
  • 1Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto and the
  • 2Department of Radiology, The Hospital for Sick Children, Toronto
  • 3The University of Toronto, Toronto, Ontario, Canada
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Publication History

Publication Date:
19 August 2004 (online)

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ABSTRACT

Small- to moderate-sized aortic thrombi in the sick newborn are frequently demonstrated, however, severe aortic thrombosis is rarely encountered. We report two newborn infants presenting with signs of decreased lower limb perfusion shortly after birth. An occlusive infrarenal aortic thrombus was demonstrated in both infants by ultrasound. No predisposing condition for thrombosis could be found in the first infant; in the second, an umbilical arterial catheter was the likely cause. The infants were successfully treated with low-molecular-weight heparin. In both infants resolution of the thrombus was observed by ultrasound. No complications of treatment were encountered. The clinical spectrum of neonatal aortic thrombosis and treatment options are reviewed.

KEYWORD

Aortic thrombosis - neonate - low-molecular-weight heparin - treatment complications - review

REFERENCES

  • 1 Vailas G N, Brouillette R T, Scott J P, Shkolnic A, Conway J, Wiringa K. Neonatal aortic thrombosis: recent experience.  J Pediatr . 1986;  109 101-108
    CrossrefPubMedSearch in Google Scholar
  • 2 Knowlson G T, Marsden H B. Aortic thrombosis in the newborn period.  Arch Dis Child . 1978;  53 164-166
    PubMedSearch in Google Scholar
  • 3 Trowitzsch E, Bernsau U, Luhmer I, Merkle W, Kallfelz H C. Congenital thrombotic occlusion of the ascending aorta and the aortic arch.  Pediatr Cardiol . 1985;  6 165-169
    PubMedSearch in Google Scholar
  • 4 Tugrul Kural I, Tinaztepe K, Yurdakul Y. Aortic thrombosis in the newborn infant.  J Cardiovasc Surg . 1984;  25 246-248
    PubMedSearch in Google Scholar
  • 5 Malin S W, Baumgart S, Rosenberg H K, Foreman J. Nonsurgical management of obstructive aortic thrombosis complicated by renovascular hypertension in the neonate.  J Pediatr . 1985;  106 630-634
    PubMedSearch in Google Scholar
  • 6 Richardson R, Applebaum H, Touran T, Franceschini R E, Robbie P A, Wirtschafter D D, Taber P. Effective thrombolytic therapy of aortic thrombosis in the small premature infant.  J Pediatr Surg . 1988;  23 1198-1200
    CrossrefPubMedSearch in Google Scholar
  • 7 Leonor M Q, Shelton L, Sun E R, Wood B P. Radiologic case of the month: idiopathic aortic thrombosis.  Am J Dis Child . 1990;  144 934-935
    PubMedSearch in Google Scholar
  • 8 Kirk C R, Bhrolchain C N, Qureshi S A. Streptokinase for aortic thrombosis.  Arch Dis Child . 1988;  63 1086-1087
    PubMedSearch in Google Scholar
  • 9 Rudas G, Bors S. Aortic thrombosis diagnosed by ultrasound.  Pediatr Radiol . 1988;  18 77-78
    PubMedSearch in Google Scholar
  • 10 Pritchard S L, Culham J A, Rogers P C. Low-dose fibrinolytic therapy in infants.  J Pediatr . 1985;  106 594-599
    PubMedSearch in Google Scholar
  • 11 Le Blanc G J, Culham J A, Chan K W, Patterson M W, Tipple M, Sandor G G. Treatment of grafts and major vessel thrombosis with low-dose streptokinase in children.  Ann Thorac Surg . 1986;  41 630-635
    PubMedSearch in Google Scholar
  • 12 Emami A, Saldanha R, Knupp C, Kodroff M. Failure of systemic thrombolytic and heparin therapy in the treatment of neonatal aortic thrombosis.  Pediatrics . 1987;  79 773-777
    PubMedSearch in Google Scholar
  • 13 Goldberg R E, Cohen A M, Bryan P J, Olsen M, Martin R J. Neonatal aortic thrombosis treated with intra-arterial urokinase therapy.  J Can Assoc Radiol . 1989;  40 55-56
    PubMedSearch in Google Scholar
  • 14 Giacoia G P. High-dose urokinase therapy in newborn infants with major vessel thrombosis.  Clin Pediatr . 1993;  32 231-237
    CrossrefPubMedSearch in Google Scholar
  • 15 Sanchez J, Velasco F, Alvarez R, Roman J, Torres A. Aortic thrombosis in a neonate with hereditary antithrombin III deficiency: successful outcome with thrombolytic and replacement treatment.  Acta Paediatr . 1996;  85 245-247
    CrossrefPubMedSearch in Google Scholar
  • 16 Hustead V A, Wicklund B M. Treatment of neonatal aortic thrombosis with urokinase.  Am J Pediatr Hematol Oncol . 1990;  12 336-339
    PubMedSearch in Google Scholar
  • 17 Corrigan Jr J J, Jeter M, Allen H D, Malone J M. Aortic thrombosis in a neonate: failure of urokinase thrombolytic therapy.  Am J Pediatr Hematol Oncol . 1982;  4 243-247
    PubMedSearch in Google Scholar
  • 18 Strife J L, Ball W S, Towbin R, Keller M S, Dillon T. Arterial occlusions in neonates: use of fibrinolytic therapy.  Radiology . 1988;  166 395-400
    PubMedSearch in Google Scholar
  • 19 Reznik V M, Anderson J, Griswold W R, Segall M L, Murphy J L, Mendoza S A. Successful fibrinolytic treatment of arterial thrombosis and hypertension in a cocaine-exposed neonate.  Pediatrics . 1989;  84 735-738
    PubMedSearch in Google Scholar
  • 20 Smith P K, Miller D A, Lail S, Mehta A V. Urokinase treatment of neonatal aortoiliac thrombosis caused by umbilical artery catheterization: a case report.  J Vasc Surg . 1991;  14 684-687
    PubMedSearch in Google Scholar
  • 21 Flanigan D P, Stolar C J, Pringle K C, Schuler J J, Fisher E, Vidyasager D. Aortic thrombosis after umbilical artery catheterization: successful surgical management.  Arch Surg . 1982;  117 371-374
    CrossrefPubMedSearch in Google Scholar
  • 22 Martin Jr J E, Moran J F, Cook L S, Goertz K K, Mattioli L. Neonatal aortic thrombosis complicating umbilical artery catheterization: successful treatment with retroperitoneal aortic thrombectomy.  Surgery . 1989;  105 793-796
    PubMedSearch in Google Scholar
  • 23 Bhat R, Fisher E, Doshi U. Neonatal abdominal aortic thrombosis.  Crit Care Med . 1981;  9 858-861
    PubMedSearch in Google Scholar
  • 24 Ahluwalia J S, Kelsall A W, Diederich S, Rennie J M. Successful treatment of aortic thrombosis after umbilical catheterization with tissue plasminogen activator.  Acta Paediatr . 1994;  83 1215-1217
    PubMedSearch in Google Scholar
  • 25 Kennedy L A, Drummond W H, Knight M E, Millsaps M M, Williams J L. Successful treatment of neonatal aortic thrombosis with tissue plasminogen activator.  J Pediatr . 1990;  116 798-801
    PubMedSearch in Google Scholar
  • 26 Torkington J, Hitchcock R, Wilkinson K, Kiely E. Successful use of recombinant tissue plasminogen activator in the treatment of aortic thrombosis in a premature neonate.  Eur J Endovasc Surg . 1997;  13 515-516
    PubMedSearch in Google Scholar
  • 27 Lofland G K, Russo P, Sethia B, de Leval M. Aortic thrombosis in neonates and infants.  Ann Surg . 1988;  208 743-745
    PubMedSearch in Google Scholar
  • 28 Hamilton R M, Penkoske P A, Byrne P, Duncan N F. Spontaneous aortic thrombosis presenting as coarctation.  Ann Thorac Surg . 1988;  45 564-565
    PubMedSearch in Google Scholar
  • 29 Krueger T C, Neblett W W, O'Neil J A, MacDonell R C, Dean R H, Thieme G A. Management of aortic thrombosis secondary to umbilical artery catheters in neonates.  J Pediatr Surg . 1985;  20 328-332
    PubMedSearch in Google Scholar
  • 30 McFadden P M, Ochsner J L. Neonatal aortic thrombosis: complication of umbilical artery cannulation.  J Cardiovasc Surg . 1983;  24 1-4
    PubMedSearch in Google Scholar
  • 31 Himmel P D, Sumner D S, Mongkolsmai C, Khanna N. Neonatal thoracoabdominal aortic thrombosis associated with the umbilical artery catheter: successful management by transaortic thrombectomy.  J Vasc Surg . 1986;  4 119-123
    PubMedSearch in Google Scholar
  • 32 Gremse D A, Peevy K J, Walterspeil J N, Johnson W H. Aortic thrombosis in a neonate with undetectable protein C.  Pediatr Radiol . 1990;  20 198-199
    PubMedSearch in Google Scholar
  • 33 McFaul R C, Keane J F, Nowicki E R, Castaneda A R. Aortic thrombosis in the neonate.  J Thorac Cardiovasc Surg . 1981;  81 334-337
    PubMedSearch in Google Scholar
  • 34 Henry C G, Gutierrez F, Lee J T. Aortic thrombosis presenting as congestive heart failure: an umbilical artery catheter complication.  J Pediatr . 1981;  98 820-822
    PubMedSearch in Google Scholar
  • 35 Kawahira Y, Kishimoto H, Iio M. Spontaneous aortic thrombosis in a neonate with multiple thrombi in the main branches of the abdominal aorta.  Cardiovasc Surg . 1995;  3 219-221
    CrossrefPubMedSearch in Google Scholar
  • 36 Zenker M, Ries M, Rauch R, Harms D. Non-catheter-related aortic thrombosis and resistance to activated protein C in a premature newborn.  Acta Paediatr . 1999;  88 1035-1043
    CrossrefPubMedSearch in Google Scholar
  • 37 Colburn M D, Gelabert H A, Quinones-Baldrich W. Neonatal aortic thrombosis.  Surgery . 1992;  11 21-28
    PubMedSearch in Google Scholar
  • 38 Streif W, Mitchell L G, Andrew M. Antithrombotic therapy in children.  Curr Opin Pediatr . 1999;  11 56-64
    CrossrefPubMedSearch in Google Scholar
  • 39 Massicotte M P, Adams M, Leaker A M, Andrew M. A nomogram to establish therapeutic levels of low molecular weight heparin (LMWH): clivarine in children requiring treatment for venous thromboembolism (VTE).  Thromb Haemost . 1997;  282
    PubMedSearch in Google Scholar
  • 40 Massicotte P, Adams M, Marzinotto V, Brooker L A, Andrew M. Low-molecular-weight heparin in pediatric patients with thrombotic disease: a dose finding study.  J Pediatr . 1996;  128 313-318
    CrossrefPubMedSearch in Google Scholar
  • 41 Fijnvandraat K, Nurmohamed M T, Peters M, Ploos van Amstel L B S, ten Cate W J. A cross-over dose finding study investigating a low molecular weight heparin (Fragmin) in six children on chronic hemodialysis.  Throm Haemost . 1993;  69 649-651
    PubMedSearch in Google Scholar
  • 42 Van Biljon I, Van Damme-Lombaerts R, Demol A, Van Geet C, Proesmans W, Arnout J. Low molecular weight heparin for anticoagulation during hemodialysis in children: a preliminary study.  Eur J Pediatr . 1996;  155 70
    PubMedSearch in Google Scholar
  • 43 Hirsh J, Levine M. Low molecular weight heparin.  Blood . 1992;  79 1-17
    PubMedSearch in Google Scholar
  • 44 Michelson A D, Bovill E, Monagle P, Andrew M. Antithrombotic therapy in children.  Chest . 1998;  114 1S-23S
    PubMedSearch in Google Scholar
  • 45 Seibert J J, Northington F J, Miers J F, Taylor B J. Aortic thrombosis after artery catheterization in neonates: prevalence of complications on long-term follow-up.  AJR . 1991;  156 567-569
    PubMedSearch in Google Scholar
  • 46 Ehrenforth S, Junker R, Koch H G. Multicentre evaluation of combined prothrombotic defects associated with thrombophilia in childhood.  Eur J Pediatr . 1999;  158 S97-S1041
    CrossrefPubMedSearch in Google Scholar