Successful treatment of arterial thrombus in an extremely low-birth-weight preterm neonate

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Thrombosis Research

Background:

• Arterial thromboembolism is a significant complication in pediatric patients, particularly following arterial catheterization.
• Neonates, especially premature infants, exhibit a heightened prothrombotic state due to physiological factors, increasing risks associated with catheterization.
• Current management strategies for arterial thrombus in neonates are not well-established and often controversial.

Observation:

• This case study focuses on an extremely low-birth-weight preterm infant experiencing catheter-related femoral artery occlusion.
• Initial treatment with continuous heparin infusion for six hours did not result in thrombus resolution.
• Heparin therapy was discontinued, and recombinant tissue plasminogen activator (rt-PA) was administered.

Findings:

• Recombinant tissue plasminogen activator (rt-PA) therapy led to complete resolution of the femoral artery thrombus in the infant.
• The administration of rt-PA was performed at a limited infusion rate of ≤0.4 mg/kg/hour.
• No adverse events, including bleeding complications, were observed during or after rt-PA treatment in this extremely low-birth-weight neonate.

Implications:

• This case suggests that rt-PA is a potentially effective and safe treatment option for arterial thromboembolism in extremely low-birth-weight preterm infants, even within the first week of life.
• The findings support the cautious use of rt-PA in this vulnerable population when conventional therapies are ineffective.
• Further research is warranted to establish definitive safety and efficacy profiles for rt-PA in neonates, particularly concerning bleeding risks like intracranial hemorrhage.