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Journal of Perinatology (2014) 34, 241243& 2014 Nature America, Inc. All rights reserved 0743-8346/14
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PERINATAL/NEONATAL CASE PRESENTATION
Spontaneous thrombosis of the abdominal aorta in two neonates
F Piersigilli1, C Auriti1, F Landolfo1, F Campi1, P Schingo2 and A Dotta1
Although relatively rare, thromboembolic events are a major complication of invasive procedures, mainly vascular catheterization, required for the survival of neonates admitted to the neonatal intensive care unit. Sometimes symptoms may be ambiguous and the diagnosis may not be immediate. The clinical relevance of polymorphism of methilene tetrahydrofolate reductase (MTHFR) gene heterozigosity and of omocystein level in the genesis of these thromboembolic events are poorly understood. We report two cases of thrombosis of the abdominal aorta, mimicking aortic coarctation, in two neonates, successfully treated at diagnosis with170 UI/Kg of low molecular weight heparin (LMWH) twice daily, without side effects. Screening for prothrombotic defects revealed the heterozygosity for MTHFR C677T in both neonates and low omocystein level in one of them. We suggest that in newborns vascular thrombosis should be considered in the differential diagnosis of acute disorders of blood circulation at birth and familial thrombophilia should be investigated. LMWH therapy with a dose of 170 UI/Kg twice daily usually allows vascular recanalization, without side effects.
Journal of Perinatology (2014) 34, 241243; doi:http://dx.doi.org/10.1038/jp.2013.154
Web End =10.1038/jp.2013.154
Keywords: abdominal aorta; neonatal thrombosis; low molecular weight heparin; factor Xa level; coarctation of the aorta
INTRODUCTIONTwo neonates were referred to our unit for suspected coarctation of the aorta. Angio computed tomography (CT) scan showed an extensive spontaneous thrombosis of the abdominal aorta. Both neonates were carrier of heterozygosity for methilene tetrahydrofolate reductase (MTHFR) C677T mutation.
CASE 1A 32 weeks newborn boy was born, by cesarean section.
Pregnancy was biamniotic dichorionic but was uneventful. At birth Apgar scores were 8 and 9 at 1 and 5 min, respectively; birth weight was 1472 g. An umbilical venous catheter was introduced. No arterial lines were placed. Because both femoral pulses were weak and pressure was not detectable in both legs, at 12 h of life the baby was transferred to our neonatal intensive care unit for a suspected coarctation of the aorta. Echocardiography excluded coarctation but Doppler ultrasound showed an important reduction of the ow in the abdominal tract...