Approach to Arterial thromboembolism in newborns (A case report)

Introduction :The increased risk of developing thrombotic events can be explained by the presence of risk factors unique to this period of time that can promote thrombosis (sepsis, inflammation, hypotension, hypoxia, and the use of intravascular catheters in small caliber vessels).The most common treatments are observation (no treatment), anti-clotting drugs (heparin ,enoxaparin) and seldom surgery. Case report :Our case was a male 5-days-old neonate .He was admitted to Shohada hospital with poor feeding , hypotonia, weight loss, weight deficit of more than 30% , icterus, severe prerenal azotemia and thrombocytopenia. After treatment of hypernatremia and azotemia with tight control during 60 hours extreme cyanosis in extremities occurred and platelet counts decreased and pt and ptt became abnormal. Doppler ultrasonography confirmed arterial thrombosis. UFH( Unfractionated heparin) was administered as an intravenous infusion and after two days was switched to LMWH (low molecular weight heparin). The dose of enoxaparin was titrated with anti Xa factor measurement .The initial dose of 1.5 mg/kg per dose of enoxaparin was injected subcutaneously every 12 hours. Then a higher doses (2.2 mg/kg/dose) was administered subcutaneously every 12 hours in order to get the target anti-factor Xa activity, of 0.5 units/mL for therapeutic anticoagulation, which is higher than upper limits that was written in literatures. During of treatment we used intermittent Doppler ultrasonography to estimate the progression of thrombosis many times. A screening head Ultrasound and brain MRI is obtained in neonates before and during initiation of antithrombotic therapy. Fortunately our patient responded to antithrombotic therapy with LMWH and his foot was treated completely. Discussion: Data from various registries, about the true frequency of thrombotic complications in newborns, have reported incidences of up to 5.1 per 100,000 live births. In neonates, UFH and LMWH are the two most commonly utilized anticoagulants. Antithrombin supplementation, either with fresh frozen plasma or antithrombin concentrate, is sometimes used for neonates in whom therapeutic heparinization has been difficult to achieve despite dose escalation. Conclusion: Thromboembolic events in the neonatal period often requires urgent intervention. Besides to conservative treatments. LMWH is the preferred agent for long-term and short-term anticoagulation in neonates.