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Archives de pédiatrie
Volume 23, n° 9
pages 951-956 (septembre 2016)
Doi : 10.1016/j.arcped.2016.03.009
Received : 14 July 2014 ;  accepted : 11 Mars 2016
Choc cardiogénique dû à une thrombose spontanée néonatale de l’aorte abdominale
Cardiogenic shock due to spontaneous neonatal thrombosis of the abdominal aorta
 

J. Brice , P. Venot, M. Colinart-Thomas, P. Morville
 Unité de réanimation infantile et pédiatrique, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France 

Auteur correspondant.
Résumé

Les thromboses artérielles néonatales sont rares et souvent associées à la présence d’un cathéter artériel ombilical. Les formes aortiques spontanées sont exceptionnelles. Elles peuvent être fatales et leur gravité tient à la morbidité rénovasculaire. Nous rapportons l’observation d’un nouveau-né à terme de 10jours ayant eu une thrombose étendue de l’aorte abdominale révélée par un choc cardiogénique provoqué par l’hypertension artérielle. La résolution a été rapide sous anticoagulants et antihypertenseurs. Le bilan étiologique a montré une insuffisance rénale et une hyperhomocystéinémie modérée traitée par supplémentation vitaminique. Cette observation est l’occasion d’une revue de la littérature sur les thromboses artérielles spontanées néonatales et d’une discussion des particularités de l’hémostase du nouveau-né. La prise en charge des thromboses artérielles néonatales varie selon les centres car il n’existe pas de recommandations françaises ou internationales concernant le bilan étiologique et le traitement à mettre en œuvre.

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Summary

Neonatal arterial thrombosis is unusual and generally associated with an arterial umbilical catheter. Spontaneous aortic thrombosis is exceptional but its severity is related to high mortality rate and renovascular morbidity. We report here the observation of a 10-day-old term infant showing a large abdominal aortic thrombosis revealed by cardiogenic shock induced by systemic arterial hypertension. The resolution was fast following anticoagulant and antihypertensive therapy. Etiologic investigations showed renal failure and moderate hyperhomocysteinemia controlled by a vitamin supplement. Following this observation, we did a brief review of the neonatal spontaneous arterial thrombosis literature to discuss the neonatal hemostasis specific aspects. Management of infants presenting an arterial thrombosis varies depending on the hospital and there are no guidelines at this time concerning the etiologic investigation and treatment in France or internationally.

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