Catheter-Directed Thrombolysis in a Neonate with Infrarenal Thrombosis: A Case Report

Background: Aortic thrombosis represents an uncommon yet severe condition in this population, often associated with umbilical arterial or venous catheterization, sepsis, prematurity, or thrombophilia. Due to its low frequency, standardized management guidelines are lacking, and therapeutic decisions are frequently extrapolated from adult data. Available treatment options include anticoagulation, systemic or catheter-directed thrombolysis, and surgical thrombectomy, each with variable reported outcomes. Given the limited evidence and absence of consensus, individual cases contribute valuable insight into therapeutic safety and effectiveness in neonates with aortic thrombosis.Case Report: A late preterm female neonate, weighing 2,500 grams, presented with congenital pneumonia and suspected sepsis, necessitating orotracheal intubation and antibiotic administration via an umbilical venous catheter. On day five, she developed vasospasm in the right lower limb, unresponsive to catheter removal. Doppler ultrasound revealed infrarenal abdominal aorta thrombosis extending to the iliac arteries. Despite being hypotensive and in poor condition, she underwent successful thrombectomy and catheter-directed thrombolysis with alteplase, with post-procedure Doppler demonstrating improved blood flow. Outpatient management with low molecular weight heparin was continued, and follow-up revealed no further thrombotic events, with thrombophilia tests remaining normal. Due to the low incidence of thromboembolic events in children, most treatment information is extrapolated from adult guidelines, with anticoagulation, thrombolytic agents, and thrombectomy as options, though no consensus exists on their use, particularly in neonates.Conclusion: This case demonstrates the utility and effectiveness of catheter-directed thrombolysis as a safe treatment method for these patients.