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Management and follow-up of arterial thrombosis in the neonatal period
R M Payne1, T C Martin, R J Bower
1Edward Mallinckrodt Department of Pediatrics of Washington University School of Medicine, St. Louis, MO.
Insights
Neonatal aortic thrombus management involved supportive care or surgical thrombectomy, with most patients surviving. Long-term follow-up showed good recovery, though initial sequelae like hypertension were common.
Area of Science:
- Cardiology
- Neonatal Medicine
- Vascular Surgery
Background:
- Major aortic thrombus formation is a rare but serious neonatal condition.
- Umbilical arterial catheters are a potential risk factor for thrombus formation.
- Associated conditions include patent ductus arteriosus, hypertension, and renal dysfunction.
Purpose of the Study:
- To report the management and outcomes of neonatal aortic thrombus.
- To evaluate the effectiveness of supportive care versus surgical thrombectomy.
- To assess long-term sequelae and recovery.
Main Methods:
- Retrospective review of 12 neonatal patients with aortic thrombus (1982-1987).
- Patients managed with supportive care or surgical thrombectomy; no thrombolytic therapy used.
- Ultrasound used to monitor thrombus resolution; follow-up assessments included blood pressure and renal function.
Main Results:
- Survival rates were high: 5/5 surgically treated and 6/7 medically treated patients survived.
- Ultrasound indicated thrombus resolution in survivors within 6-30 days.
- Initial sequelae included hypertension (9/11 survivors) and decreased renal function (6/11 survivors).
Conclusions:
- Both supportive care and surgical thrombectomy can be effective for neonatal aortic thrombus.
- Most survivors experience resolution of thrombus and good long-term recovery.
- Hypertension and renal dysfunction are common initial sequelae but often resolve over time.
Abstract:
The management and follow-up of 12 patients with major aortic thrombus formation occurring in the neonatal period between 1982 and 1987 are reported. Umbilical arterial catheters were inserted in 8 of the 12 patients before thrombus formation. Two patients had congenital thrombi. Hypertension, oliguria, hematuria, and elevated blood creatinine concentration were found at the time of diagnosis of the thrombus; nine of the patients had a patent ductus arteriosus. Supportive care was instituted in seven patients who were hemodynamically stable. Five of the patients had congestive heart failure, shock, or both, and were treated with surgical thrombectomy. Thrombolytic therapy was not used in either group. The five surgically treated patients and six of seven medically treated patients survived. Ultrasound examination suggested resolution of the thrombus in all survivors in 6 to 30 days. Sequelae from thrombus formation were present in all patients at the time of discharge and included hypertension in 9 of the 11 survivors and decreased renal function in six of them. Follow-up at 1 to 3 years revealed normal blood pressure, good growth, and good renal function in 10 of the survivors.