TROMBOSE VENOSA CENTRAL NÃO RELACIONADA A CATETER CENTRAL EM RECÉM-NASCIDO: RELATO DE CASO

Abstract

Introduction: Central venous thrombosis (CVT) in neonates is an uncommon condition, typically linked to central venous catheter use. When spontaneous, its early recognition is challenging due to nonspecific clinical signs and limited reports in the literature.

Case Description: A term female neonate, born via cesarean section at 38 weeks and 3 days of gestation, weighing 3100g, with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively, without need for resuscitation and had a normal initial physical exam. The mother had a prior diagnosis of type 1 diabetes mellitus, treated with insulin and metformin during pregnancy, and an obstetric history of three previous pregnancies, including two cesarean deliveries and one miscarriage. On postnatal day 1, the infant developed symmetrical upper limb myoclonic jerks during the first 48 hours of life. Cranial ultrasonography revealed hemorrhagic lesions, and brain Magnetic Resonance Imaging (MRI) demonstrated hemorrhagic venous infarction in the right anterior thalamus, with thrombosis of the right internal cerebral vein and thalamic drainage vein. Electroencephalography showed no epileptiform activity. Treatment with enoxaparin and phenobarbital was initiated, with favorable clinical progression and hospital discharge on day 10.

Discussion: This case underscores the importance of clinical suspicion and early diagnosis of neonatal CVT, even in the absence of central venous catheters, the most common risk factor. Neonatal coagulation immaturity contributes to thrombotic vulnerability, and low molecular weight heparin appears safe and effective in this population.

Conclusion: Spontaneous neonatal CVT is rare but clinically significant. Prompt recognition and appropriate management are critical to improving outcomes and minimizing neurological sequelae, even when classical risk factors are absent.