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Acute aortic thrombosis following umbilical artery catheterisation in extremely low birthweight infants: walking the tight rope of management
  1. Boon Siew Ooi,
  2. Krishna Revanna Gopagondanahalli and
  3. Shrenik Vora
  1. Neonatology, KK Women's and Children's Hospital, Singapore
  1. Correspondence to Dr Boon Siew Ooi; ooi.boon.siew{at}kkh.com.sg

Abstract

Umbilical artery catheterisation (UAC) is crucial in the management of clinically sick infants. One of its dreaded complications is aortic thrombus formation which accounts for significant morbidity and mortality. We present the case of a premature infant born at 32 weeks of gestation and with a birth weight of 960 gm, who developed signs of acute lower limb ischaemia following UAC cannulation. Ultrasound Doppler scan confirmed large aortic thrombus involving iliac arteries. Heparin infusion was started with clinical improvement over the next 12 hours and eventual complete resolution of clot size. This case underscores the importance of prompt detection of acute aortic thrombosis and cautions the use of heparin infusion in preterm infants can be lifesaving. Management can be challenging as risk of bleeding from anticoagulation and thrombolytic therapy can be catastrophic in extreme low birthweight premature infants and need to weigh with risk of severe intravascular haemorrhage.

  • Neonatal intensive care
  • Haematology (incl blood transfusion)
  • Healthcare improvement and patient safety

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BSO, KRG, SV. The following author gave final approval of the manuscript: SV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.