Spontaneous External Iliac Artery Thrombosis in a Newborn: Successful Management with Early Anticoagulation

Neonatal arterial thrombosis is rare, with an incidence of 0.5 per 10,000 live births, and spontaneous occurrence immediately at birth represents an exceptionally uncommon presentation.We report a male infant born at 37 weeks' gestation via emergency cesarean section for placental abruption, whose mother had gestational diabetes mellitus and sickle cell trait.At six minutes of life, the neonate developed marked pallor of the left lower extremity with absent femoral pulses, indicating acute limb ischemia.Doppler ultrasound demonstrated complete occlusion of the left external iliac artery by a 3-cm thrombus.The infant was successfully treated with continuous intravenous unfractionated heparin titrated to therapeutic activated partial thromboplastin time.Clinical improvement was evident within 24 hours, and complete thrombus resolution with full recanalization was achieved within seven days without bleeding or other complications.The patient was discharged on day 7 with normal limb perfusion and remained asymptomatic during follow-up, with normal thrombophilia screening.This case adds to the limited literature on spontaneous neonatal external iliac artery thrombosis and underscores the importance of immediate clinical recognition, prompt Doppler imaging, and early anticoagulation therapy.With timely intervention, excellent outcomes with limb preservation can be achieved even in cases of extensive proximal arterial thrombosis at the moment of birth.