Jump to comment:

• CMV infection should be investigated among the causes of neonatal arterial thrombosis.
  Marcello Lanari
  Published on: 22 March 2016

• Published on: 22 March 2016

  CMV infection should be investigated among the causes of neonatal arterial thrombosis.

  • Marcello Lanari, neonatologist
  • Other Contributors:
    • Giacomo Faldella

  Dear Editor,

  Kenny and Goodman reported on four cases of neonatal arterial thrombosis presenting as congenital heart disease (1). Arterial thrombosis is rare in neonates and even more rare in the aorta as it occurs most frequently in the iliac, femoral and cerebral arteries, mainly secondary to catheterization of an umbilical artery. Thus, the description of four cases of “spontaneous” neonatal arterial thrombosis i...

  Show More

  Dear Editor,

  Kenny and Goodman reported on four cases of neonatal arterial thrombosis presenting as congenital heart disease (1). Arterial thrombosis is rare in neonates and even more rare in the aorta as it occurs most frequently in the iliac, femoral and cerebral arteries, mainly secondary to catheterization of an umbilical artery. Thus, the description of four cases of “spontaneous” neonatal arterial thrombosis is interesting as is the discussion on active management. However, we would like to point out that the aetiology of thrombosis remained unknown in 3 out of 4 cases and that investigation was mainly limited to thrombophilia screening.Inherited thrombophilia is actually an important thrombosis risk factor but not the only one. In 2001 we described a case of congenital aortic arch thrombosis in a female newborn delivered by cesarean section at 37 weeks of gestation because ultrasonography revealed fetal cardiomegaly and cardiac hypertrophy and it was difficult to image the aorta and aortic flow, mimicking a congenital aortic coarctation (2).The clinical, laboratory, virologic and anatomopathologic findings and the absence of other causes of aortic thrombosis,in primis inherited thrombophilia, made it possible to attribute the case to a severe congenital cytomegalovirus(CMV)infection. The literature contains many case reports on the role of CMV infection in vascular thrombosis (3). It is now known that herpesviruses, particularly CMV, can infect and grow in endothelial cells, altering the thromboresistant surface of intact vascular endothelium by mechanisms that directly damage the endothelium and procoagulant activity. CMV is the most common congenital infection and its prevalence in newborns ranges between 0.2 and 2.2% (4). A wide spectrum of disease severity has been documented: the majority of infected newborns are asymptomatic but ~15% have disseminated disease and central nervous system involvement with severe sequelae. Thus, we believe that CMV infection should be included in the investigation of neonatal arterial thrombosis, because detection of congenital CMV infection will allow prompt therapeutic and rehabilitative strategies to curb subsequent damage.

  References:

  1. Kenny D, Tsai-Goodman B. Neonatal arterial thrombus mimicking congenital heart disease. Archives of Disease in Childhood - Fetal and Neonatal Edition 2007;92:F59-F61.

  2. Lanari M, Lazzarotto T, Papa I, Venturi V, Bronzetti G, Guerra B, Faldella G, Corvaglia L, Picchio FM, Landini MP, Salvioli GP. Neonatal Aortic Arch Thrombosis as a Result of Congenital Cytomegalovirus Infection. Pediatrics Vol. 108 No. 6 December 2001, pp. e114.

  3. Abgueguen P, Delbos V, Chennebault JM, Payan C, Pichard E. Vascular thrombosis and acute cytomegalovirus infection in immunocompetent patients: report of 2 cases and literature review. Clin Infect Dis. 2003 Jun 1;36(11):E134-9.

  4. Stagno S. Cytomegalovirus. In: Remington JS, Klein JO, eds. Infectious Disease of the Fetus and Newborn Infant. 5th ed. Philadelphia, PA: WB Saunders Co; 2001:389–424.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top