Spontaneous neonatal aortic thrombosis in the setting of hypernatremic dehydration: a multifactorial etiology — a case report and literature review

Spontaneous neonatal aortic thrombosis is a rare but life-threatening condition with potentially severe complications, including limb ischemia and organ dysfunction. While hypernatremic dehydration has been occasionally linked to thrombotic events in the absence of central vascular catheterization, such occurrences remain uncommon. We report the case of an eight-day-old full-term male neonate presenting with fever, poor feeding, and severe dehydration associated with hypernatremia. The infant, born to a mother carrying the sickle cell trait, developed hypertension, hepatomegaly, and progressive cyanosis of the left toes, suggesting distal ischemia. Echocardiography and CT angiography revealed a large thrombus in the descending aorta with preserved visceral perfusion and extensive collateral circulation, suggesting with chronic thrombosis of antenatal origin. The patient was managed with unfractionated heparin, followed by systemic thrombolysis with streptokinase, resulting in marked thrombus regression and restoration of perfusion. Neonatal aortic thrombosis, though rare, can be fatal and may arise without iatrogenic risk factors. Imaging is key to assessing thrombus chronicity. Cautious use of systemic thrombolysis may be effective when surgery is not feasible. Long-term monitoring is essential for detecting delayed complications. Not applicable.