Spontaneous neonatal humeral artery thromboembolism: a case report

Correspondence to Dr Joana Faustino; joanamotafaustino@gmail.com Description Neonatal spontaneous arterial thromboembolism is uncommon and therefore data on risk factors, diagnostic strategies, therapeutic interventions and follow-up are scarce.1 2 Increased risk of thromboembolic events occurs in the neonatal period both due to maternal risk factors and relative immaturity of the neonatal haemostatic system.1 3 Most common maternal risk factors are advancedmaternal age, obesity, infections, pre-eclampsia, hypertension, caesareansection, decreased fetal movements, oligohydramnios, induction with prolongedlabour, lupus or diabetes.1 Treatment and follow-up in a tertiary reference centre is recommended, because it seems to be associated with high mortality and morbidity.1 A male neonate was born at 38 weeks gestational age from a previously healthy 33-year-old mother with a body mass index of 24 kg/m2. An arterial thrombotic event was suspected, and the neonate was transferred to a level III paediatric centre, where anticoagulation was initially started with unfractionated heparin, followed by low molecular weight heparin (LMWH) adjusted to anti-factor Xa levels. Doppler sonography revealed normal flow in the right arm arteries down to the elbow, an echogenic thrombus with 22 mm×3 mm in the deep humeral artery and absent arterial flow downstream (figure 2).