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Encerramento precoce do canal arterial por um trombo oclusivo : caso clínico de duas patologias raras
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Introdução: A trombose é uma entidade rara na idade pediátrica, apresentando dois picos de incidência, um deles no período neonatal. Resulta de particularidades da fisiologia da hemostase neonatal e da presença de fatores de risco maternos, neonatais adquiridos ou genéticos. O canal arterial é um vaso sanguíneo fisiológico no desenvolvimento fetal com o objectivo de desviar o sangue da vasculatura pulmonar, enquanto os pulmões ainda não são funcionantes.
Objetivo: Apresentar um caso clínico de encerramento do canal arterial por trombo, dando a conhecer uma localização rara de trombose neonatal que condicionou o seu encerramento precoce.
Caso Clínico: Apresenta-se o caso de uma recém-nascida, prematura de 34 semanas, que nasceu de cesariana por cardiotocograma fetal não tranquilizador. Diagnóstico pré-natal de trombo oclusivo do canal arterial às 33 semanas e 6 dias. Seguimento pósnatal através de ecocardiogramas seriados que mostraram trombo estável e com redução das suas dimensões. Teve alta aos 30 dias de vida com referenciação para consultas de Cardiologa Pediátrica, Neonatologia e Hematologia Pediátrica para avaliação analítica da coagulação aos 6 meses.
Conclusões: A gestão de um caso clínico como o apresentado demonstra a importância de uma equipa médica multidisciplinar com a capacidade de integrar elementos de diferentes patologias no mesmo doente. A avaliação de todos os elementos fisiológicos, como as alterações causadas pelo encerramento precoce do canal arterial, e fisiopatológicos, na origem do trombo, é fundamental, sendo necessário avaliar o doente como um todo, não apenas como conjunto de patologias isoladas, para garantir uma abordagem correta e que potencie o melhor desfecho possível. O conhecimento destas patologias e da sua terapêutica é limitado pela escassez de material científico existente em Pediatria e especialmente em Neonatologia, tornando-se a experiência dos clínicos um fator importante na abordagem destas situações raras.
Introduction: Neonatal thrombosis is a rare but important pathology during the paediatric period, which presents itself with incidence peaks, one of them in newborns. Such is a consequence of particularities inherent to the physiology of neonatal haemostasis and the presence of maternal, acquired neonatal and genetic risk factors. The ductus arteriosus is a blood vessel physiological in the foetal development. It has an indispensable function to deviate blood from the pulmonary vessels while the lungs are non-functioning. Objective: To present a clinical case of closure of the ductus arteriosus by a thrombus, shedding light on a rare location of neonatal thrombosis which conditioned the premature closure of the vessel. Case Report: We present the case of a premature newborn (caesarean section at 34 weeks of gestation due to non-assuring foetal cardiotocogram) with prenatal diagnosis of premature closure of the ductus arteriosus at 33 weeks and 6 days due to the presence of an occlusive thrombus. The patient is managed through support therapy with a series of echocardiograms that show a stable thrombus with diminishing size. The patient is discharged after 30 days with a referral for a follow-up appointment of paediatric cardiology, neonatology and paediatric haematology for analytical evaluation of coagulation at 6 months of age. Conclusions: The management of a clinical case as the one presented shows the importance of a medical team that can integrate elements of different pathologies in the same patient. The evaluation of all the physiological and pathophysiological elements is fundamental, making it necessary to approach the patient as a whole, not just as a gathering of individual diseases, in order to ensure the best possible outcome. The knowledge of these pathologies, and its therapeutics, is limited by the scarce amount of scientific literature in Paediatrics, especially Neonatology, in which the experience of the physicians is an important factor in the outcome of rare combinations of pathologies.
Introduction: Neonatal thrombosis is a rare but important pathology during the paediatric period, which presents itself with incidence peaks, one of them in newborns. Such is a consequence of particularities inherent to the physiology of neonatal haemostasis and the presence of maternal, acquired neonatal and genetic risk factors. The ductus arteriosus is a blood vessel physiological in the foetal development. It has an indispensable function to deviate blood from the pulmonary vessels while the lungs are non-functioning. Objective: To present a clinical case of closure of the ductus arteriosus by a thrombus, shedding light on a rare location of neonatal thrombosis which conditioned the premature closure of the vessel. Case Report: We present the case of a premature newborn (caesarean section at 34 weeks of gestation due to non-assuring foetal cardiotocogram) with prenatal diagnosis of premature closure of the ductus arteriosus at 33 weeks and 6 days due to the presence of an occlusive thrombus. The patient is managed through support therapy with a series of echocardiograms that show a stable thrombus with diminishing size. The patient is discharged after 30 days with a referral for a follow-up appointment of paediatric cardiology, neonatology and paediatric haematology for analytical evaluation of coagulation at 6 months of age. Conclusions: The management of a clinical case as the one presented shows the importance of a medical team that can integrate elements of different pathologies in the same patient. The evaluation of all the physiological and pathophysiological elements is fundamental, making it necessary to approach the patient as a whole, not just as a gathering of individual diseases, in order to ensure the best possible outcome. The knowledge of these pathologies, and its therapeutics, is limited by the scarce amount of scientific literature in Paediatrics, especially Neonatology, in which the experience of the physicians is an important factor in the outcome of rare combinations of pathologies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Trombose Neonatologia Canal arterial Prematuridade Pediatria