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Arterial occlusions in neonates: use of fibrinolytic therapy
J L Strife1, W S Ball, R Towbin
1Division of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Fibrinolytic therapy effectively treated symptomatic thrombosis in neonates, particularly central thrombosis after umbilical artery catheterization. Prompt diagnosis and treatment are crucial for positive outcomes in these critical cases.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Vascular Surgery
Background:
- Umbilical artery catheterization is associated with neonatal thrombosis.
- Prompt recognition and management of neonatal extremity ischemia or aortic thrombosis are critical.
Purpose of the Study:
- To review diagnostic methods and treatment responses to fibrinolytic agents in neonates with symptomatic thrombosis.
- To evaluate the efficacy of fibrinolytic therapy for peripheral and central thrombosis in infants.
Main Methods:
- Retrospective review of eight infants with symptomatic thrombosis treated with fibrinolytic agents.
- Diagnostic tools included real-time sonography and umbilical arteriography.
- Analysis of treatment response and patient outcomes.
Main Results:
- Fibrinolytic therapy achieved complete lysis in one of two infants with peripheral thrombosis.
- Five of six infants with central thrombosis experienced complete clot lysis.
- One premature infant developed intracranial hemorrhage and died.
Conclusions:
- Fibrinolytic therapy is a viable treatment option for neonatal thrombosis, especially central thrombosis.
- Early diagnosis via sonography and arteriography aids management.
- Careful patient selection and monitoring are essential due to potential complications.
Abstract:
For neonates with ischemia of an extremity or extensive thrombosis of the aorta after umbilical artery catheterization, prompt recognition and management decisions are necessary. The cases of eight infants with symptomatic thrombosis who were treated with fibrinolytic agents were retrospectively reviewed to study means of diagnosis and response to therapy. Peripheral thrombosis was seen in two otherwise healthy infants; fibrinolytic therapy produced complete lysis in one and partial lysis in the other. The six infants with central thrombosis presented with low Apgar scores and multiple clinical problems; umbilical catheters were already in place. To assess the clot, real-time sonography was performed in all six patients, and umbilical arteriograms were obtained in five. Fibrinolytic therapy produced complete lysis of clot in five of the six infants. The one death occurred in a premature infant in whom a large intracranial hemorrhage developed 6 hours after institution of therapy.