Gabriela Etzel Gomes de Sa1, Miguel Machado Carlos Lopes2, Raquel Alexandra Barbosa de Nunes Gouveia Lopes2, Isabel Sampaio2, Maria da Graça Rocha Oliveira2, Rita Espírito Santo2, Maria João Palaré2.
1Faculdades Pequeno Príncipe, Curitiba, PR, Brasil,
2Departamento de Pediatria do Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal.
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Abstract
Introduction: Neonatal thrombosis affects approximately 3 to 5 out of every 100,000 newborns, with a mortality rate of 2 to 4%. Its occurrence may be associated with conditions involving the mother and the fetus/newborn and/or related to the medical assistance.
Case description: A full-term newborn (NB) of biamniotic bicorionic twin pregnancy, with excellent adaptation to extrauterine life, presented sudden hematuria at 28 hours of life, evolving with the need for invasive ventilation and hemodynamic support. Abdominal ultrasound revealed extensive venous thrombosis affecting the infrahepatic inferior vena cava and common iliac veins. The anatomopathological study of the placenta revealed the presence of an intervillous thrombus measuring 1.5 centimeters. The thrombotic condition was managed by the use of subcutaneous Enoxaparin and hospital discharge occurred after 45 days of hospitalization.
Discussion: The thrombus found in the intervillous space of the placenta suggests that it was the result of a maternal coagulative response as a result of a disturbance in maternal-fetal blood flow. Therefore, we believe that the thrombus found in the NB has the same origin as the thrombus found in the placenta, suggesting that the placental intervillous coagulation product has migrated to the fetal circulation. It is recommended to start the investigation of neonatal venous thrombosis through Doppler ultrasound. With regard to treatment, the agents of choice are low molecular weight heparins (LMWH), especially subcutaneous Enoxaparin sodium. It is understood that the mother-fetus binomial faced hemodynamic disorders, however, etiopathogenic clarifications are still lacking to define the triggering factor of the coagulation dysfunction.
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