Background: Spontaneous neonatal arterial thrombosis is a rare entity with serious and potentially fatal complications. A wide spectrum of management has been proposed.
Case report: Ophélie was born after premature delivery at 33 weeks. She was referred soon after birth in the neonatal intensive care unit for respiratory distress syndrome. Spontaneous acute ischemia of the right lower limb was noted soon after admission. Iliac thrombosis was confirmed by ultrasonography and colour coded doppler. Thrombolysis was achieved with systemic infusion of recombinant tissue plasminogen activator (rtPA). Full recovery was obtained within 12 hours of treatment without any complication. No rethrombosis occurred with heparin prophylaxis. No predisposing disorder to thrombosis was found.
Conclusion: Systemic rtPA is an alternative to thrombectomy and urokinase in critically ill neonates. This treatment should be considered if no major risk of bleeding is found during the pretherapeutic screening.