# Management of Neonatal Aortic Thrombosis: Challenges and Outcomes With Systemic and Intra-arterial Thrombolysis

## TL;DR

This paper discusses the challenges and outcomes of treating a rare condition called neonatal aortic thrombosis using different types of thrombolysis in a critically ill newborn.

## Contribution

The paper presents a case study highlighting the complexities of managing neonatal aortic thrombosis with systemic and intra-arterial thrombolysis.

## Key findings

- Initial anticoagulation with heparin was insufficient for treating the neonate's thrombosis.
- Intra-arterial thrombolysis with reteplase led to clinical improvement despite limited Doppler study results.
- The patient was discharged on low-molecular-weight heparin, emphasizing the need for individualized treatment strategies.

## Abstract

Neonatal aortic thrombosis, though rare, is associated with high mortality and is frequently linked to umbilical vessel catheterization, especially in smaller and critically ill infants due to their low levels of natural anticoagulants and increased prothrombotic activity. We report a case of a term neonate with abdominal aortic thrombosis and severe lower limb ischemia, presenting with respiratory distress requiring intubation and subsequent development of thrombosis by day 7. Initial anticoagulation with heparin proved insufficient, necessitating the use of reteplase and intra-arterial thrombolysis, which resulted in clinical improvement despite limited immediate success in Doppler studies. The patient was discharged on low-molecular-weight heparin against medical advice, highlighting the complexities and need for individualized management strategies in neonatal thromboembolism.