PMID- 27599834
OWN - NLM
STAT- MEDLINE
DCOM- 20171120
LR  - 20181113
IS  - 1471-2431 (Electronic)
IS  - 1471-2431 (Linking)
VI  - 16
IP  - 1
DP  - 2016 Sep 6
TI  - Case report of a central venous access device-associated thrombosis with aortic 
      embolism in a preterm infant.
PG  - 154
LID - 10.1186/s12887-016-0691-x [doi]
LID - 154
AB  - BACKGROUND: Thrombosis in neonates is commonly a central venous access device 
      (CVAD) associated complication. Furthermore, a patent foramen ovale (PFO) is 
      frequently seen in preterm infants. Even though a coincidence of both is not 
      unusual, detaching of the thrombus and organisation of an aortic embolism has not 
      been described until now. Treatment recommendations of CVAD-associated thrombosis 
      in neonates do not consider frequently seen complications of preterm infants e.g. 
      intraventricular haemorrhage. This is the first case of a very preterm infant 
      with pre-existing intraventricular haemorrhage, who developed a CVAD-associated 
      thrombosis and thromboembolic complications. CASE PRESENTATION: The authors 
      report on a very preterm girl with a pre-existing intraventricular haemorrhage 
      and a CVAD-associated thrombus that, after removal of the CVAD, led to assumed 
      pulmonary embolism and to an extended aortic embolism with consequent cerebral 
      stroke. The girl was treated with unfractionated heparin (UFH) for about 50 days. 
      During the further in-hospital stay the girl developed a mild bronchopulmonary 
      dysplasia. Follow-up revealed clinical signs of cerebral palsy. CONCLUSION: Even 
      though preterm infants are often diagnosed with a PFO which constitutes the risk 
      for paradoxical embolism, such complications do not occur frequently due to the 
      physiological heart pressure proportion. Nevertheless, it is important to monitor 
      vital parameters and cerebral perfusion after removing a CVAD with confirmed 
      associated thrombosis, because thromboembolic complications are possible. If 
      practicable, patients with a confirmed CVAD-associated thrombosis should be 
      anticoagulated before removing the CVAD. However, in our patient it was rational 
      to remove the CVAD without prior anticoagulation due to the pre-existing 
      intraventricular haemorrhage. There are various treatment recommendations for 
      thrombosis or embolism in infants. However, there are no clear recommendations in 
      very preterm infants with a high risk of cerebral bleeding respectively a 
      pre-existing intraventricular haemorrhage. We decided to treat our patient with 
      unfractionated heparin until the affected vessels were recanalised. Finally, it 
      remains a case-by-case decision how to treat CVAD-associated thrombosis and 
      consequent embolism depending on the patient's medical history.
FAU - Biermayr, Marlene
AU  - Biermayr M
AD  - Department of Paediatrics II, Neonatology, Medical University of Innsbruck, 
      Anichstrasse 35, 6020, Innsbruck, Austria.
FAU - Brunner, Barbara
AU  - Brunner B
AD  - Department of Paediatrics II, Neonatology, Medical University of Innsbruck, 
      Anichstrasse 35, 6020, Innsbruck, Austria.
FAU - Maurer, Kathrin
AU  - Maurer K
AD  - Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
FAU - Trawoeger, Rudolf
AU  - Trawoeger R
AD  - Department of Paediatrics II, Neonatology, Medical University of Innsbruck, 
      Anichstrasse 35, 6020, Innsbruck, Austria.
FAU - Kiechl-Kohlendorfer, Ursula
AU  - Kiechl-Kohlendorfer U
AD  - Department of Paediatrics II, Neonatology, Medical University of Innsbruck, 
      Anichstrasse 35, 6020, Innsbruck, Austria.
FAU - Neubauer, Vera
AU  - Neubauer V
AD  - Department of Paediatrics II, Neonatology, Medical University of Innsbruck, 
      Anichstrasse 35, 6020, Innsbruck, Austria. Vera.Neubauer@i-med.ac.at.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20160906
PL  - England
TA  - BMC Pediatr
JT  - BMC pediatrics
JID - 100967804
SB  - IM
MH  - Aortic Diseases/diagnosis/*etiology
MH  - Central Venous Catheters/*adverse effects
MH  - Cerebral Hemorrhage/complications
MH  - Device Removal/*adverse effects
MH  - Embolism, Paradoxical/diagnosis/*etiology
MH  - Female
MH  - Humans
MH  - Infant, Newborn
MH  - Infant, Premature
MH  - Infant, Premature, Diseases/diagnosis/*etiology
MH  - Pulmonary Embolism/diagnosis/etiology
MH  - Stroke/diagnosis/etiology
MH  - Venous Thrombosis/diagnosis/*etiology
PMC - PMC5012094
OTO - NOTNLM
OT  - Aortic embolism
OT  - Case report
OT  - Central venous access device
OT  - Paradoxical stroke
OT  - Preterm
OT  - Thrombosis
EDAT- 2016/09/08 06:00
MHDA- 2017/11/29 06:00
PMCR- 2016/09/06
CRDT- 2016/09/08 06:00
PHST- 2016/03/17 00:00 [received]
PHST- 2016/08/27 00:00 [accepted]
PHST- 2016/09/08 06:00 [entrez]
PHST- 2016/09/08 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2016/09/06 00:00 [pmc-release]
AID - 10.1186/s12887-016-0691-x [pii]
AID - 691 [pii]
AID - 10.1186/s12887-016-0691-x [doi]
PST - epublish
SO  - BMC Pediatr. 2016 Sep 6;16(1):154. doi: 10.1186/s12887-016-0691-x.