Neonatal Arterial Thrombosis at Birth: Case Report and Literature Review

ABSTRACT

Neonatal thromboembolism is rare and in most cases iatrogenic from indwelling central catheters, peripheral arterial lines, and umbilical lines. It often requires urgent intervention to restore perfusion and to avoid morbidity and even mortality. Very few case reports of neonatal arterial thrombosis at birth are described in the literature. We present the case of a full-term infant noted to have marked left arm swelling at birth. Doppler ultrasound of the arm demonstrated a large thrombus in the left subclavian, axillary, and brachial arteries. He underwent left arm fasciotomy and anticoagulant therapy with good recovery. We present this case with a brief review of the literature.

KEYWORDS

Neonatal thromboembolism - arterial thrombosis - venous thrombosis - anticoagulation - fasciotomy - prothrombotic disorders

REFERENCES

• 1 Nowak-Gottl U, von Kries R, Gobel U. Neonatal symptomatic thromboembolism in Germany: two year survey.  Arch Dis Child Fetal Neonatal Ed. 1997;  76 F163
• 2 Boffa M C, Lachassinne E. Infant perinatal thrombosis and antiphospholipid antibodies: a review.  Lupus. 2007;  16(8) 634-641
• 3 Andrew M, Paes B, Milner R et al.. Development of the human coagulation system in the full-term infant.  Blood. 1987;  70(1) 165-172
• 4 Reverdiau-Moalic P, Delahousse B, Body G, Bardos P. Evolution of blood coagulation activators and inhibitors in the healthy human fetus.  Blood. 1996;  88(3) 900-906
• 5 Andrew M, Paes B, Johnston M. Development of the hemostatic system in the neonate and young infant.  Am J Pediatr Hematol Oncol. 1990;  12(1) 95-104
• 6 Andrew M, Schmidt B, Mitchell L, Paes B. Thrombin generation in newborn plasma is critically dependent on the concentration of prothrombin.  Thromb Haemost. 1990;  63(1) 27-30
• 7 Andrew M E, Monagle P, deVeber G, Chan A K. Thromboembolic disease and antithrombotic therapy in newborns.  Hematology (Am Soc Hematol Educ Program). 2001;  1 358-374
• 8 Andrew M, Monagle P, Brooker L. Arterial thromboembolic complications in pediatric patients, thromboembolic complications during infancy and childhood. Hamilton, Ontario; BC Decker 2000: 165-200
• 9 Hoar P F, Wilson R M, Mangano D T, Avery G J, Szarnicki R J, Hill J D. Heparin bonding reduces thrombogenicity of pulmonary-artery catheters.  N Engl J Med. 1981;  305(17) 993-995
• 10 Downs J B, Chapman Jr R L, Hawkins Jr I F. Prolonged radial artery catheterization. An evaluation of heparinized catheters and continuous irrigation.  Arch Surg. 1974;  108(5) 671-673
• 11 Evaluation of the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines: The AACN Thunder Project. By the American Association of Critical-Care Nurses.  Am J Crit Care. 1993;  2 3-15
• 12 Greenberg R, Waldman D, Brooks C, Ouriel K. Endovascular treatment of renal artery thrombosis caused by umbilical artery catheterization.  J Vasc Surg. 1998;  28(5) 949-953
• 13 Brown M S, Phibbs R H. Spinal cord injury in newborns from use of umbilical artery catheters: report of two cases and a review of the literature.  J Perinatol. 1988;  8(2) 105-110
• 14 Caplan M S, Cohn R A, Langman C B, Conway J A, Shkolnik A, Brouillette R T. Favorable outcome of neonatal aortic thrombosis and renovascular hypertension.  J Pediatr. 1989;  115(2) 291-295
• 15 Seibert J J, Northington F J, Miers J F, Taylor B J. Aortic thrombosis after umbilical artery catheterization in neonates: prevalence of complications on long-term follow-up.  AJR Am J Roentgenol. 1991;  156(3) 567-569
• 16 Glickstein J S, Rutkowski M, Schacht R, Friedman D. Renal blood flow velocity in neonates with and without umbilical artery catheters.  J Clin Ultrasound. 1994;  22(9) 543-550
• 17 Boros S J, Nystrom J F, Thompson T R, Reynolds J W, Williams H J. Leg growth following umbilical artery catheter-associated thrombus formation: a 4-year follow-up.  J Pediatr. 1975;  87(6 Pt 1) 973-976
• 18 Letts M, Blastorah B, al Azzam S. Neonatal gangrene of the extremities.  J Pediatr Orthop. 1997;  17(3) 397-401
• 19 Munoz M E, Roche C, Escriba R, Martinez-Bermejo A, Pascual-Castroviejo I. Flaccid paraplegia as complication of umbilical artery catheterization.  Pediatr Neurol. 1993;  9(5) 401-403
• 20 Edstrom C S, Christensen R D. Evaluation and treatment of thrombosis in the neonatal intensive care unit.  Clin Perinatol. 2000;  27(3) 623-641
• 21 Roy M, Turner-Gomes S, Gill G et al.. Accuracy of Doppler echocardiography for the diagnosis of thrombosis associated with umbilical venous catheters.  J Pediatr. 2002;  140(1) 131-134
• 22 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry.  Pediatrics. 1995;  96(5 Pt 1) 939-943
• 23 Nowak-Gottl U, von Kries R, Gobel U. Neonatal symptomatic thromboembolism in Germany: two year survey.  Arch Dis Child Fetal Neonatal Ed. 1997;  76(3) F163-F167
• 24 Tanke R B, van Megen R, Daniels O. Thrombus detection on central venous catheters in the neonatal intensive care unit.  Angiology. 1994;  45(6) 477-480
• 25 Kooiman A M, Kootstra G, Zwierstra R P. Portal hypertension in children due to thrombosis of the portal vein.  Neth J Surg. 1982;  34(3) 97-103
• 26 Parker M J, Joubert G I, Levin S D et al.. Portal vein thrombosis causing neonatal cerebral infarction.  Arch Dis Child Fetal Neonatal Ed. 2002;  87(2) F125-F127
• 27 Zigman A, Yazbeck S, Emil S, Nguyen L. Renal vein thrombosis: a 10-year review.  J Pediatr Surg. 2000;  35(11) 1540-1542
• 28 Gunther G, Junker R, Strater R et al.. Symptomatic ischemic stroke in full-term neonates: role of acquired and genetic prothrombotic risk factors.  Stroke. 2000;  31(10) 2437-2441
• 29 Hibbert J, Howlett D C, Greenwood K L, MacDonald L M. The ultrasound appearances of neonatal renal vein thrombosis.  Br J Radiol. 1997;  70(839) 1191-1194
• 30 Cremin B J, Davey H, Oleszczuk-Raszke K. Neonatal renal venous thrombosis: sequential ultrasonic appearances.  Clin Radiol. 1991;  44(1) 52-55
• 31 Wright N B, Blanch G, Walkinshaw S, Pilling D W. Antenatal and neonatal renal vein thrombosis: new ultrasonic features with high frequency transducers.  Pediatr Radiol. 1996;  26(9) 686-689
• 32 Estan J, Hope P. Unilateral neonatal cerebral infarction in full term infants.  Arch Dis Child Fetal Neonatal Ed. 1997;  76(2) F88-F93
• 33 Bednarek N, Morville P, Delebarre G et al.. Necrotic skin lesions and cerebral infarction in the newborn: two case reports.  J Child Neurol. 2007;  22(3) 354-357
• 34 Dix D, Andrew M, Marzinotto V, Charpentier K. The use of low molecular weight heparin in pediatric patients: a prospective cohort study.  J Pediatr. 2000;  136(4) 439-445
• 35 Hirsh J, Raschke R. Heparin and low-molecular-weight heparin. The Seventh ACCP Conference of Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126(3, Suppl) 188S-203S
• 36 Andrew M, Marzinotto V, Massicotte P et al.. Heparin therapy in pediatric patients: a prospective cohort study.  Pediatr Res. 1994;  35(1) 78-83
• 37 Juergens C P, Semsarian C, Keech A C et al.. Hemorrhagic complications of intravenous heparin use.  Am J Cardiol. 1997;  80(2) 150-154
• 38 Warkentin T E, Chong B H, Greinacher A. Heparin-induced thrombocytopenia: towards consensus.  Thromb Haemost. 1998;  79(1) 1-7
• 39 Warkentin T E, Levine M N, Hirsh J et al.. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin.  N Engl J Med. 1995;  332(20) 1330-1335
• 40 Demasi R, Bode A P, Knupp C et al.. Heparin-induced thrombocytopenia.  Am Surg. 1994;  60(1) 26-29
• 41 Albisetti M, Andrew M. Low molecular weight heparin in children.  Eur J Pediatr. 2002;  161(2) 71-77
• 42 Massicotte P, Adams M, Marzinotto V et al.. Low-molecular-weight heparin in pediatric patients with thrombotic disease: a dose finding study.  J Pediatr. 1996;  128(3) 313-318
• 43 Andrew M, Brooker L, Leaker M, Paes B. Fibrin clot lysis by thrombolytic agents is impaired in newborns due to a low plasminogen concentration.  Thromb Haemost. 1992;  68(3) 325-330
• 44 Ries M, Easton R L, Longstaff C, Zenker M. Differences between neonates and adults in tissue-type-plasminogen activator (t-PA)-catalyzed plasminogen activation with various effectors and in carbohydrate sequences of fibrinogen chains.  Thromb Res. 2001;  103(3) 173-184
• 45 Manco-Johnson M J, Grabowski E F, Hellgreen M, Kemahli A S. 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(1) 157-158
• 46 Monagle P, Chan A, Massicotte P et al.. Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126(3, Suppl) 645S-687S
• 47 Lin P H, Dodson T F, Bush R L et al.. Surgical intervention for complications caused by femoral artery catheterization in pediatric patients.  J Vasc Surg. 2001;  34(6) 1071-1078
• 48 Hedrick M, Elkins R C, Knott-Craig C J, Razook J D. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature.  J Thorac Cardiovasc Surg. 1993;  105(2) 297-301
• 49 Ragland III R, Moukoko D, Ezaki M et al.. Forearm compartment syndrome in the newborn: report of 24 cases.  J Hand Surg [Am]. 2005;  30(5) 997-1003
• 50 Hsi A C, Davis D J, Sherman F C. Neonatal gangrene in the newborn infant of a diabetic mother.  J Pediatr Orthop. 1985;  5(3) 358-360