TREATMENT OF NEONATAL AORTIC THROMBOSIS W ITH RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR (TPA)

Background. - Aortic thrombosis is more frequent since the use of umbi lical artery catheters in neonatal intensive care units. Some drugs or surgery are proposed to prevent complications; experience with tissue plasminogen activator (tPA) is still limited. Case report no 1. - A n eonate, weighing 2400 g, developed respiratory distress requiring inse rtion of a catheter into her umbilical artery at H12. Ultrasonography on day 3 showed aortic thrombosis extending to the right renal artery which was confirmed by angiography. tPA 0.1 mg/kg was administered thr ough the catheter, followed by 0.3 mg/kg/h for 3 hours and heparin, 10 0 IU/kg/hour for 54 hours. Angiography, performed 18 hours later, show ed complete disappearance of the thrombosis. Case report no 2. - A neo nate, weighing 2520 g suffered at 12 hours of life from seizures, apne a and bradycardia which required insertion of a catheter into her umbi lical artery. Cyanosis of the right leg with weakening of femoral puls ations, 14 hours later, lead to the diagnosis of aortic thrombosis whi ch was confirmed by aortography. The patient was given tPA 0.1 mg/kg f ollowed by 0.3 mg/kg/h for 3 hours and heparin 100 IU/kg/hour for 6 ho urs. Amplitude of femoral pulsations strikingly increased within 6 hou rs with the disappearance of cyanosis. Conclusion. - These results sug gest that tPA can be useful in neonates presenting with aortic thrombo sis.