PB0649 - Two Case Reports of Neonatal Acute Limb Ischaemia secondary to Catheter-Related Arterial Thrombosis (CAT) Resolving with Anticoagulation Therapy

Background: Neonatal arterial thrombosis usually occurs secondary to arterial catheterization. Clinical presentation includes acute limb ischaemia, arterial hypertension and heart failure. Management of Neonatal CAT remains controversial and available data is scarce.

Aims: To describe 2 cases of neonatal acute limb ischaemia secondary to CAT resolving with anticoagulation.

Methods: Data on the clinical course were obtained from medical records retrospectively.

Results: Both cases were preterm neonates born at 32 weeks (Case 1) and 36 weeks (Case 2). Case 1, small for gestational age, had mild respiratory distress syndrome requiring continuous positive airway pressure. Case 2, Alpha Thalassaemia Major had 3 intra-uterine transfusions. Postnatally, required regular red cell transfusions and had persistent pulmonary hypertension of newborn requiring high frequency oscillatory ventilation.

Both cases presented with lower limb ischemia secondary to umbilical arterial catheter (UAC) related thrombosis. Case 1 presented with bilateral lower limb acute ischaemia at Day 4 of life. UAC was removed with minimal improvement in perfusion. Ultrasound doppler showed thrombus at bifurcation of distal aorta extending into both common iliac arteries. Case 2 presented with right lower limb acute ischaemia at Day 7 of life after removal of UAC. Ultrasound doppler showed thrombus over right distal common iliac artery extending to proximal internal iliac artery and distal common femoral artery.

Both cases started on IV heparin infusion, were subsequently converted to subcutaneous enoxaparin. Gradual improvement achieved in perfusion and thrombus resolution by Day 13 for Case 1 and Day 21 for Case 2. Anticoagulation discontinued after thrombus resolution. There were no long-term sequelae from the thrombosis.

Conclusion(s): Anticoagulation as a standalone treatment for neonatal acute limb ischaemia secondary to CAT can be considered in cases where acute limb ischaemia secondary to CAT can be considered in cases where acute limb ischaemia is not severe with close monitoring for improvement in perfusion.