Superior vena cava syndrome associated with a peripherally inserted central catheter in a very low birth weight preterm infant
DOI:
https://doi.org/10.37497/JMRReview.v5i00.1481Keywords:
Infant, Premature, Catheterization, Central Venous, Venous Thrombosis, Superior Vena Cava Syndrome, EnoxaparinAbstract
Background: Peripherally inserted central catheters (PICCs) are widely used in neonatal units for medication administration and parenteral nutrition. However, their use can be associated with central venous thrombosis, causing serious complications such as superior vena cava syndrome. In premature newborns, the concomitant presence of intracranial hemorrhage makes therapeutic management particularly challenging due to the risk of bleeding during anticoagulation.
Aim: To report a case of superior vena cava syndrome associated with thrombosis after PICC insertion in a very low birth weight premature infant, highlighting the therapeutic challenges in the face of concomitant intracranial hemorrhage and the clinical evolution during anticoagulation.
Method: Descriptive case report study based on the analysis of the clinical evolution of a premature newborn who developed central venous thrombosis associated with a PICC. Clinical findings, imaging studies, therapeutic management, and evolution during hospital follow-up were evaluated.
Results: A newborn with a gestational age of 29 weeks and 3 days and a weight of 1,190 g presented with edema of the face, neck, and trunk after PICC insertion. Echocardiography identified an image suggestive of a 6 mm thrombus in the innominate vein and superior vena cava, while transfontanellar ultrasound showed grade II intracranial hemorrhage. After multidisciplinary evaluation, anticoagulation with enoxaparin was initiated. Serial examinations demonstrated progressive reduction of the thrombus to 5 mm and 3 mm, with no thrombus described after 25 days. The intracranial hemorrhage resolved in the follow-up performed after 14 days. Anticoagulation was maintained for 42 days, with favorable clinical evolution and hospital discharge in stable condition.
Conclusion: Central venous thrombosis associated with PICC should be considered in the presence of facial, cervical, and trunk edema in premature infants. The concomitant presence of intracranial hemorrhage requires individualized assessment of the risks and benefits of anticoagulation, with multidisciplinary follow-up and serial imaging examinations. In this case, treatment with enoxaparin was accompanied by resolution of thrombosis and hemorrhage, demonstrating a favorable outcome. However, further studies are needed to establish the safety and the best therapeutic strategy in similar situations.
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