Neonatal necrotizing enterocolitis caused by umbilical arterial catheter-associated abdominal aortic embolism: A case report

BACKGROUND: Reports of necrotizing enterocolitis (NEC) caused by umbilical arterial catheter (UAC)-associated abdominal aortic embolism in neonates are rare. Herein, we report the case of an extremely low birth weight (ELBW) infant with NEC caused by UAC-associated abdominal aortic embolism. CASE SUMMARY: A female infant, aged 21 min and weighing 830 g at 28(+6 )wk of gestational age, was referred to our hospital because of premature birth and shallow breathing. The patient was diagnosed with ELBW, neonatal respiratory distress syndrome, neonatal intrauterine infection, and neonatal asphyxia. Umbilical arterial and venous catheters were inserted on the day after birth and were removed 9 d later, according to the doctor’s plan. Within 48 h after extubation, the patient’s manifestations included poor responsiveness, heart rate range of 175-185/min, and currant jelly stool. Therefore, we considered a diagnosis of NEC. To determine the cause, we used B-mode ultrasound, which revealed a partial abdominal aortic embolism (2 cm × 0.3 cm) and abdominal effusion. The patient was treated with nil per os, gastrointestinal decompression, anti-infective therapy, blood transfusion, and low-molecular-weight heparin sodium q12h for anticoagulant therapy (from May 20 to June 1, the dosage of low-molecular-weight heparin sodium was adjusted according to the anti-Xa activity during treatment). On the 67(th )day after admission, the patient fully recovered and was discharged. CONCLUSION: The abdominal aortic thrombosis in this patient was considered to be catheter related, which requires immediate treatment once diagnosed. The choice of treatment should be determined according to the location of the thrombus and the patient’s condition.