Neonatal arterial thrombosis associated with maternal paraganglioma: a case report

Abstract

Introduction: Neonatal arterial thrombosis is a rare but life-threatening condition, most often associated with umbilical catheterization, congenital thrombophilia, or perinatal complications. Maternal pheochromocytomas and paragangliomas (PPGLs) are rare during pregnancy, and their impact on neonatal hemostasis remains poorly understood. Objective: To describe a case of neonatal arterial thrombosis associated with maternal PPGL and its implications for neonatal care. Case description: We report a case of neonatal arterial thrombosis associated with maternal paraganglioma. A female neonate was born at 37 weeks via cesarean section to a 29-year-old woman with a 9.4 cm retroperitoneal paraganglioma. The infant had normal Apgar scores (9/9) and birth weight of 2,922g. On admission to the neonatal intensive care unit, she exhibited pallor, cyanosis, and decreased temperature of the left lower limb. Doppler ultrasound revealed a thrombus extending from the common femoral artery to the superficial femoral artery origin. Thrombophilia screening was negative. The mother experienced severe postpartum hypertension requiring nitroprusside, suggesting massive catecholamine release during delivery. The infant was treated with intravenous heparin followed by subcutaneous enoxaparin. Follow-up Doppler ultrasound at 20 days showed complete thrombus resolution and the infant was discharged without complications. Discussion: Excessive maternal catecholamine release during delivery may overwhelm placental metabolic capacity, leading to fetal exposure and subsequent arterial thrombosis. Pediatric healthcare providers should be aware of this potential risk, as early recognition and prompt anticoagulation therapy can lead to favorable outcomes.