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Effective thrombolytic therapy of aortic thrombosis in the small premature infant
R Richardson1, H Applebaum, T Touran
1Division of Pediatric Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027.
Insights
Aortic thrombosis in premature infants is challenging. Local intra-arterial streptokinase infusion effectively resolved ischemic symptoms without complications in a small infant cohort.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Vascular Surgery
Background:
- Aortic thrombosis presents a significant diagnostic and therapeutic challenge in very-low-birthweight premature infants.
- Symptoms often include extremity and/or visceral ischemia, necessitating urgent evaluation.
- Indwelling umbilical artery catheters are frequently implicated as a cause.
Purpose of the Study:
- To evaluate diagnostic and therapeutic strategies for aortoiliac thrombosis in premature infants.
- To assess the efficacy and safety of local intra-arterial streptokinase infusion for treating aortic thrombosis.
Main Methods:
- Nine very-low-birthweight premature infants with symptoms of ischemia were evaluated.
- Aortoiliac thrombosis was diagnosed, likely secondary to umbilical artery catheter use.
- Angiography via catheter was employed for diagnosis.
- Local intra-arterial streptokinase (50 U/kg/h) was infused directly into the thrombus for 36 hours.
Main Results:
- Angiography proved to be the most effective diagnostic method.
- Intra-arterial streptokinase infusion led to the resolution of ischemic symptoms in all treated infants.
- No complications were observed during or after the streptokinase treatment protocol.
Conclusions:
- Local intra-arterial streptokinase infusion is an effective and safe treatment for aortic thrombosis in premature infants.
- This therapeutic approach offers a viable solution to a previously unresolved clinical dilemma.
- Prompt diagnosis via angiography is crucial for successful management.
Abstract:
Aortic thrombosis in the very-low-birthweight premature infant has remained both a diagnostic and a therapeutic dilemma. Nine small infants were evaluated for symptoms of extremity and/or visceral ischemia. All were found to have aortoiliac thrombosis most likely related to indwelling umbilical artery catheters. Diagnostic and therapeutic options were evaluated. An angiogram obtained through the catheter was found to be the most effective diagnostic technique. Local infusion of intra-arterial streptokinase (50 U/kg/h) directly into the clot for 36 hours resulted in resolution of ischemic symptoms. No complications were encountered with the use of this protocol.