1 - Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Pediatric Haematology Unit, Hospital Dona Estefania, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Publicação em versão integral
- Comunicação oral em congresso internacional
Resumo:
Neonatal spontaneous arterial thromboembolism is uncommon and therefore data on risk factors, diagnostic strategies, therapeutic interventions and follow-up are scarce. Increased risk of thromboembolic events occurs in the neonatal period both due to maternal risk factors and relative immaturity of the neonatal haemostatic system. Most common maternal risk factors are advancedmaternal age, obesity, infections, pre-eclampsia, hypertension, caesareansection, decreased fetal movements, oligohydramnios, induction with prolongedlabour, lupus or diabetes. Treatment and follow-up in a tertiary reference centre is recommended, because it seems to be associated with high mortality and morbidity. A male neonate was born at 38 weeks gestational age from a previously healthy 33-year-old mother with a body mass index of 24 kg/m2. Pregnancy was complicated by third-trimester gestational diabetes, which required treatment with metformin. Eutocic delivery occurred at a level II perinatal hospital, after 12 hours of labour. No sign of maternal infection was detected. The newborn weighed 3195 g and had an APGAR index of 9 at the first minute and 10 at the fifth minute. Presented at birth with right upper limb cyanosis, pale hand, non-palpable pulse and unmeasurable peripheral oxygen saturation. An arterial thrombotic event was suspected, and the neonate was transferred to a level III paediatric centre, where anticoagulation was initially started with unfractionated heparin, followed by low molecular weight heparin (LMWH) adjusted to anti-factor Xa levels. Blood tests at 24 hours were normal, with haemoglobin 19,6 g/L, haematocrit 54.5% and platelets 213×109/L . Doppler sonography revealed normal flow in the right arm arteries down to the elbow, an echogenic thrombus with 22 mm×3 mm in the deep humeral artery and absent arterial flow downstream. At third postnatal day, the patient developed fever and early-onset neonatal sepsis was suspected with C protein reaction of 50 mg/L (reference <5 mg/L), thrombocytopaenia 50×109/L (reference 200–250×109/L). LMWH was maintained and therapy with ampicillin, gentamicin and flucloxacillin was started, with no adverse events. Blood culture was negative. There was a progressive normalization of clinical and imaging features in the upper limb. The infant was kept on LMWH for 4 months with complete resolution. Screening for thrombophilias were negative.
Palavras Chave: Haematology (incl blood transfusion); neonatal health; venous thromboembolism