Successful Use of Thrombolysis in an Extremely Low Birth Weight, Premature Infant With Aortic Thrombosis

Abstract

Background: Severe neonatal aortic thrombosis is rare but can lead to significant morbidity or death if inadequately treated. Thrombolytic therapy is indicated for thrombi which are life-threatening, organ-threatening, or limb-threatening, but dosing consensus has not been established.Observation: We report a case of a 700 g preterm neonate with spontaneous intestinal perforation who developed an occlusive aortic thrombus with signs of limb ischemia. He was treated successfully with tissue plasminogen activator without hemorrhagic complications. He was started at a dose of 0.06 mg/kg/h and received a maximum dose of 0.3 mg/kg/h. Long-term follow-up at 3 years and 3 months showed no negative sequelae. Conclusion:Alteplase may be considered in premature, extremely low-birth weight infants with careful assessment of risk and benefits, along with frequent surveillance and supportive care.

Successful thrombolysis in a preterm newborn with acute Leriche syndrome caused by spontaneous thrombotic aortoiliac occlusion: a case report and review of the literature

“…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 .…”

“…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 .…”