Thrombotic aortic occlusion in neonates: A case report and review of the literature

<h3>Abstract</h3> Aortic occlusion in neonates owing to thrombosis is a rare and potentially life-threatening condition if left untreated. Treatment requires a patient-specific approach. This report describes a full-term macrosomic newborn presenting with pallor and hypotonic lower extremities. Duplex ultrasound examination and computed tomography angiography demonstrated spontaneous aortic occlusion caused by a thrombus extending from the infrarenal aorta to both iliac arteries. Systemic thrombolysis with tissue plasminogen activator was initiated but discontinued after 6 hours owing to intracerebral hemorrhage. Despite discontinuation of thrombolysis, limb perfusion improved and the thrombus resolved completely within 2 weeks without further anticoagulation. Prophylactic anticoagulation was administered for three 3. After 6 months, motor development was normal, with no observed neurological deficits. Neonatal aortic thrombosis is rare, and the existing literature remains scarce. Treatment strategies are highly patient specific, requiring careful consideration between supportive care, anticoagulation therapy, thrombolytics, and surgical thrombectomy. Current recommendations suggest supportive care for mild cases, anticoagulation as the mainstay for moderate disease, and thrombolytic therapy for severe, organ- or limb-threatening thrombosis. Surgical thrombectomy should be considered for refractory disease or when systemic thrombolysis is contraindicated. The current case suggests that systemic thrombolytic therapy with tissue plasminogen activator may yield successful outcomes in neonates with major thrombosis leading to aortic occlusion. However, there is no clear consensus on the optimal dosage, route of administration, or duration of thrombolysis. Further research is necessary to develop comprehensive, evidence-based recommendations for the management of neonatal aortic thrombosis.