The newborn was born by cesarean section at 36 weeks of gestation, weighing 3100 g, from a 30-year-old pregnant mother 2, to 1.
The results of the prenatal screening tests in maternal serum did not present particularities.
She had no history of hypertension, systemic lupus erythematosus, diabetes mellitus, nephropathy or thrombotic diathesis.
At 4 hours of life, the newborn presented with chronic cough and tachypnea.
Located at the nearest hospital.
The chest X-ray showed ground glass opacities in both lungs with poorly defined cardiac margins.
She was connected to a ventilator and surfactant was administered.
At this moment, he had no central line.
At 12 hours of life, the right side was pale and cold, 3 cm below the knee.
The dorsal artery pulse of the right foot was not palpable.
Leukocyte count was 16 370/mm3 with 75% neutrophils.
Hematocrit and C-reactive protein (CRP) levels were normal.
The possibility of thrombophilia was evaluated.
Protein C, protein S and antithrombin levels were normal.
No homozygous C677T polymorphism of the methylentetrahydrofolate reductase gene (MTHFR), V Leiden heterozygous factor, or G20210A mutation of the gene were found.
The platelet count was 96 000/mm3.
Prothrombin time was 15.6 s (normal, 10.1-15.9 s).
The activated partial thromboplastin time was 40.9 s (normal, 31.3-54.3 s).
Fibrinogen concentration was 115 pg/dl (normal, 167399 pg/dl).
Sickle cell density was 13 536 pg/L (normal, 0-500 pg/L).
On computed tomography angiography (CT), internal iliac artery arising from the iliac bifurcation was not observed.
However, the right femoral artery was visualized at the level of half of the thigh by recanalization.
The distal, popliteal, anterior and posterior tibial arteries were also not observed.
The peak flow of the right femoral artery was low and slower than that of the left femoral artery.
The venous flow was preserved.
After detecting vascular occlusion caused by arterial thromboembolism, thrombolysis was immediately performed and frozen tissue fibrinogen activator (TPA) was administered at a dose of 0.5 mg/kg/h fresh for 6 hours.
Simultaneously, unopposed heparin (20 U/kg/h) was administered to maintain anticoagulation at low doses.
1.
Before thrombolytic treatment, a brain ultrasound was performed to investigate bleeding.
Despite treatment, viability remained unchanged.
On the third day, a surgical thrombectomy was performed.
It was not possible to restore arterial flow to the apex.
At 20 days of life, an amputation below the knee was performed.
