Neonatal arterial thrombosis is a rare but extremely severe condition with a variable death rate.

To evaluate treatment options and outcomes in a series of hyperacute presentations of intracardiac, aortic or arterial thrombosis in neonates.

All neonates with proven aortic or arterial thrombus without iatrogenic aetiology were reviewed retrospectively in a single-centre series from January 1990 to September 2023. Clinical presentation was reviewed, as well as diagnostic tools used. Treatment, outcomes and potential aetiologies were analysed.

Seventeen neonates (six females) were identified from our database. Twelve were diagnosed between day 0 and day 1, and the rest in first week. The modes of presentation were antenatal ventricular asymmetry ( n = 3), cardiogenic shock ( n = 6), limb ischaemia ( n = 4), seizure ( n = 2) and pulmonary hypertension ( n = 2). The thrombus locations were thoracic aorta ( n = 4), abdominal aorta ( n = 5), coronary arteries ( n = 2), left atrial appendage ( n = 2), foramen ovale ( n = 1) and limb arteries ( n = 3). Five patients had surgical removal, four had percutaneous treatment (including thromboaspiration, thrombolysis and stent implantation) and seven had heparin infusion only. Two patients received parenteral thrombolysis. Two patients with coronary thrombosis ultimately died, one patient had limb amputation and the other patients had a complete cardiac recovery. Only one patient had a heterozygous factor V Leiden mutation as a potential thrombophilia.

All therapeutic strategies should be discussed in multidisciplinary team, ranging from heparin infusion to surgical resection. Endovascular therapy is a valid option in a substantial number of patients.