Female newborn, fruit of monochorionic diamniotic twin pregnancy, born by cesarean section by a mother with preeclampsia at 31+5 weeks of gestation, weighing 1,010 g.
Apgar 6/8.
She was born with mild respiratory distress, and complained, a chest X-ray was performed suggesting hyaline membrane disease grade 2, so it was decided to intubate to administer surfactant, with radiological improvement and subsequent extubation.
Umbilical catheters were installed without immediate complications.
At 10 days of life, cardiac murmur was diagnosed and echocardiography was indicated, revealing thrombus in the inferior vena cava (IVC) and entry of the right atrium (RA).
Since this thrombus could be associated with the presence of umbilical catheter, anticoagulation with subcutaneous LMWH was initiated.
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A new echocardiography was performed at 14 days of life in which a patent foramen ovale (FO), thrombus in the IVC and AD that passed through the FO toward the left atrium (LA) was observed.
The patient was evaluated with a cardiovascular medical team for thrombolytic therapy with r-TPA.
This therapy could not be performed because the control tests showed an increase in acute phase reactants, endocarditis being diagnosed.
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Hb: Hemoglobin; Hto: hematocrit; CRP: C-reactive protein.
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For this reason it was decided to polycultivate and start empirical antibiotic therapy with third generation cephalosporins.
With positive blood cultures and abnormal cerebrospinal fluid (CSF), late nosocomial sepsis with meningeal involvement was diagnosed.
Ampicillin-susceptible Enterococcus faecalis was isolated in the hemocultive. Ampicillin plus gentamicin therapy was changed to complete treatment for 4-6 weeks.
A control echocardiography was performed at one month of life, highlighting a decrease in the size of the thrombus, with negative control hemocultives and a decrease in CRP. Aspirin was ruled out after 4-6 weeks of treatment.
