Abdominal Aortic Thrombosis in a Preterm Baby With Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a serious congenital anomaly often associated with pulmonary hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Central vascular access such as umbilical arterial catheters (UACs) is routinely used in neonatal intensive care but is associated with the risk of vascular complications, including thromboembolic events. We present a case of preterm dichorionic diamniotic (DCDA) twins born at 34 weeks of gestation with antenatally diagnosed CDH. The baby developed severe respiratory distress requiring high-frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), and sildenafil infusion. Hemodynamic instability required inotropic support and UAC placement. Surgical repair of CDH was performed on the fifth day of life. Postoperatively, the baby developed iliofemoral and renal artery thrombosis, leading to global infarction of the left kidney. Anticoagulation was initiated with heparin and transitioned to enoxaparin. The neonate showed significant clinical improvement and was discharged in stable condition with preserved right renal function.