{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T23:13:53Z","timestamp":1780528433154,"version":"3.54.1"},"reference-count":62,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Intracardiac thrombi in preterm infants are not common but may lead to fatal outcomes. Predisposing and risk factors include small vessel size, hemodynamic instability, immaturity of the fibrinolytic system, indwelling central catheters and sepsis. In this paper, we present our own experience with a case of a catheter-related right atrial thrombus in a preterm infant, which was successfully treated with an aspiration thrombectomy. Then, we review the literature on intracardiac thrombosis in preterm infants: epidemiology, pathophysiology, clinical signs, echocardiographic diagnostic features and treatment options are discussed.<\/jats:p>","DOI":"10.3390\/diagnostics13040764","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T03:53:49Z","timestamp":1676606029000},"page":"764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Intracardiac Thrombi in Preterm Infants\u2014A Case Study and Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"given":"Ayala","family":"Gover","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, Bnai-Zion Medical Center, Haifa 3339419, Israel"},{"name":"Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawod","family":"Sharif","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Cardiology, Bnai-Zion Medical Center, Haifa 3339419, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liat","family":"Yaniv","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Cardiology, Bnai-Zion Medical Center, Haifa 3339419, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5937-9620","authenticated-orcid":false,"given":"Arieh","family":"Riskin","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Bnai-Zion Medical Center, Haifa 3339419, Israel"},{"name":"Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"883","DOI":"10.2165\/00128072-200103120-00002","article-title":"Management of preterm infants with intracardiac thrombi: Use of thrombolytic agents","volume":"3","author":"Rimensberger","year":"2001","journal-title":"Paediatr. Drugs"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.thromres.2008.12.002","article-title":"Management and investigation of neonatal thromboembolic events: Genetic and acquired risk factors","volume":"123","author":"Saracco","year":"2009","journal-title":"Thromb. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/pbc.21714","article-title":"Risk factors for umbilical venous catheter-associated thrombosis in very low birth weight infants","volume":"52","author":"Narang","year":"2009","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1080\/14767058.2020.1743668","article-title":"Neonatal thrombosis","volume":"35","author":"Makatsariya","year":"2022","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"F423","DOI":"10.1136\/archdischild-2011-301142","article-title":"The preterm infant with thrombosis","volume":"97","author":"Bhat","year":"2012","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0268-960X(03)00042-0","article-title":"Neonatal thrombosis and its treatment","volume":"18","author":"Greenway","year":"2004","journal-title":"Blood Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/MBC.0b013e328364f9b0","article-title":"Neonatal central venous catheter thrombosis: Diagnosis, management and outcome","volume":"25","author":"Park","year":"2014","journal-title":"Blood Coagul. Fibrinolysis Int. J. Haemost. Thromb."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.siny.2015.10.005","article-title":"Thromboembolism and anticoagulation management in the preterm infant","volume":"21","author":"Rajagopal","year":"2016","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"F66","DOI":"10.1136\/fn.85.1.F66","article-title":"Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator","volume":"85","author":"Ferrari","year":"2001","journal-title":"Arch. Dis. Child.. Fetal Neonatal Ed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1378\/chest.99.4.963","article-title":"Great vein and right atrial thrombosis in critically ill infants and children with central venous lines","volume":"99","author":"Berman","year":"1991","journal-title":"Chest"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/MBC.0b013e3283333c7c","article-title":"Neonatal and childhood right atrial thrombosis: Recognition and a risk-stratified treatment approach","volume":"21","author":"Yang","year":"2010","journal-title":"Blood Coagul. Fibrinolysis Int. J. Haemost. Thromb."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1016\/j.clnu.2018.06.952","article-title":"ESPGHAN\/ESPEN\/ESPR\/CSPEN guidelines on pediatric parenteral nutrition: Venous access","volume":"37","author":"Kolacek","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/j.1536-4801.2005.tb00011.x","article-title":"1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR)","volume":"41","author":"Koletzko","year":"2005","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1055\/s-0038-1660852","article-title":"Hemostasis in the Very Young","volume":"44","author":"Kenet","year":"2018","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/ijlh.12531","article-title":"Developmental hemostasis: Laboratory and clinical implications","volume":"38","author":"Toulon","year":"2016","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1111\/jth.13130","article-title":"Coagulation indices in very preterm infants from cord blood and postnatal samples","volume":"13","author":"Neary","year":"2015","journal-title":"J. Thromb. Haemost. JTH"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1111\/j.1651-2227.1997.tb14816.x","article-title":"Coagulation and fibrinolytic systems in the ill preterm newborn","volume":"86","author":"Mautone","year":"1997","journal-title":"Acta Paediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s11239-013-0936-6","article-title":"Giant right atrial thrombus in premature newborn","volume":"37","author":"Baykan","year":"2014","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1651-2227.1998.tb01533.x","article-title":"Successful use of tissue plasminogen activator (t-PA) in catheter-related intracardiac thrombi of two premature infants","volume":"87","author":"Giuffre","year":"1998","journal-title":"Acta Paediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1055\/s-0034-1396567","article-title":"Atrial Thrombus in a Neonate: A Diagnostic Challenge","volume":"5","author":"Sheen","year":"2015","journal-title":"AJP Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1111\/jth.12699","article-title":"No impact of endogenous prothrombotic conditions on the risk of central venous line-related thrombotic events in children: Results of the KIDCAT study (KIDs with Catheter Associated Thrombosis)","volume":"12","author":"Thom","year":"2014","journal-title":"J. Thromb. Haemost. JTH"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1542\/peds.81.2.284","article-title":"Right atrial thrombus formation screening using two-dimensional echocardiograms in neonates with central venous catheters","volume":"81","author":"Marsh","year":"1988","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1542\/peds.2005-1880","article-title":"A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams","volume":"118","author":"Buzzard","year":"2006","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/archdischild-2018-316762","article-title":"Thrombosis after umbilical venous catheterisation: Prospective study with serial ultrasound","volume":"105","author":"Visser","year":"2020","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4103\/1995-705X.125924","article-title":"Cardiac thrombi in different clinical scenarios","volume":"14","author":"Alkindi","year":"2013","journal-title":"Heart Views Off. J. Gulf Heart Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1002\/clc.4960180910","article-title":"Intracardiac thrombi: Frequency, location, etiology, and complications: A morphologic review\u2014Part II","volume":"18","author":"Waller","year":"1995","journal-title":"Clin. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1007\/s00246-010-9777-7","article-title":"Left atrial appendage thrombus in a preterm neonate in sinus rhythm with septic shock","volume":"31","author":"Aswani","year":"2010","journal-title":"Pediatr. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.ijcard.2007.07.049","article-title":"Unusual left atrial appendage thrombus in a neonate with normal heart after sustained supraventricular tachycardia","volume":"131","author":"Russo","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1055\/s-2007-994752","article-title":"Central venous line thrombosis in premature infants: A case management and literature review","volume":"10","author":"Alkalay","year":"1993","journal-title":"Am. J. Perinatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1007\/s00246-015-1199-0","article-title":"Recombinant Tissue Plasminogen Activator in the Treatment of Neonates with Intracardiac and Great Vessels Thrombosis","volume":"36","author":"Khan","year":"2015","journal-title":"Pediatr. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/S0022-3476(81)80725-1","article-title":"Echocardiographic diagnosis of intracardiac thrombi complicating total parenteral nutrition","volume":"98","author":"Mahony","year":"1981","journal-title":"J. Pediatr."},{"key":"ref_32","first-page":"e407","article-title":"Use of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight infants","volume":"12","author":"Bose","year":"2011","journal-title":"Pediatr. Crit. Care Med. A J. Soc. Crit. Care Med. World Fed. Pediatr. Intensive Crit. Care Soc."},{"key":"ref_33","first-page":"1763","article-title":"Clinical features and treatment results in preterm infants with intracardiac thrombus","volume":"34","author":"Kara","year":"2021","journal-title":"J. Matern. -Fetal Neonatal Med. Off. J. Eur. Assoc. Perinat. Med. Fed. Asia Ocean. Perinat. Soc. Int. Soc. Perinat. Obs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1007\/s004310051182","article-title":"Local low-dose urokinase treatment of acquired intracardiac thrombi in preterm infants","volume":"158","author":"Aspesberro","year":"1999","journal-title":"Eur. J. Pediatr."},{"key":"ref_35","first-page":"115","article-title":"Combined thrombolytic therapy for atrial thrombus in a preterm infant","volume":"63","author":"Mondi","year":"2011","journal-title":"Minerva Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e28544","DOI":"10.1002\/pbc.28544","article-title":"Thrombolytic therapy in preterm infants: Fifteen-year experience","volume":"67","author":"Garanito","year":"2020","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1136\/adc.67.4_Spec_No.443","article-title":"Intracardiac thrombus formation with rapidly progressive heart failure in the neonate: Treatment with tissue type plasminogen activator","volume":"67","year":"1992","journal-title":"Arch. Dis. Child."},{"key":"ref_38","first-page":"275","article-title":"Candida septicemia and right atrial mass secondary to umbilical vein catheterization","volume":"135","author":"Johnson","year":"1981","journal-title":"Am. J. Dis. Child."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1093\/oxfordjournals.eurheartj.a062020","article-title":"Right atrial thrombosis in two premature infants: Successful treatment with urokinase and heparin","volume":"7","author":"Pongiglione","year":"1986","journal-title":"Eur. Heart J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S0022-3476(86)80849-6","article-title":"Intracardiac thrombi complicating central total parenteral nutrition: Resolution without surgery or thrombolysis","volume":"108","author":"Mendoza","year":"1986","journal-title":"J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.1590\/S0066-782X2007000500026","article-title":"Combined rTPA and aspirin therapy for intracardiac thrombosis in neonates","volume":"88","author":"Tardin","year":"2007","journal-title":"Arq. Bras. De Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0022-5223(19)38087-0","article-title":"Right atrial ball-valve thrombus: A complication of central venous alimentation in an infant. Diagnosis and successful surgical management of a case","volume":"78","author":"Pliam","year":"1979","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_43","first-page":"S48","article-title":"Atrial Thrombus in a Premature Newborn Following Cardio-Pulmonary Resuscitation","volume":"26","author":"Ali","year":"2016","journal-title":"J. Coll. Physicians Surg. Pak. JCPSP"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"The European Cooperative Study on the clinical significance of right heart thrombi (1989). European Working Group on Echocardiography. Eur. Heart J., 10, 1046\u20131059.","DOI":"10.1093\/oxfordjournals.eurheartj.a059427"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1136\/archdischild-2022-323789","article-title":"Is recombinant tissue plasminogen activator treatment a safe choice in very and extremely preterm infants with intracardiac thrombosis?","volume":"107","author":"Ciarcia","year":"2022","journal-title":"Arch. Dis. Child."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/00003246-198701000-00011","article-title":"Broviac catheterization in low birth weight infants: Incidence and treatment of associated complications","volume":"15","author":"Sadiq","year":"1987","journal-title":"Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/S0022-3468(97)90581-9","article-title":"Surgical emergency embolectomy for the treatment of fulminant pulmonary embolism in a preterm infant","volume":"32","author":"Gamillscheg","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e1317","DOI":"10.1542\/peds.2014-3242","article-title":"Successful pulmonary embolectomy of a saddle pulmonary thromboembolism in a preterm neonate","volume":"135","author":"Kalaniti","year":"2015","journal-title":"Pediatrics"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e737S","DOI":"10.1378\/chest.11-2308","article-title":"Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"Monagle","year":"2012","journal-title":"Chest"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1160\/TH03-02-0089","article-title":"Thrombophilia does not increase risk for neonatal complications in preterm infants","volume":"90","author":"Kenet","year":"2003","journal-title":"Thromb. Haemost."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1007\/PL00014337","article-title":"Coagulation-associated complications of indwelling arterial and central venous catheters during heparin prophylaxis\u2014A prospective study","volume":"158","author":"Hentschel","year":"1999","journal-title":"Eur. J. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.thromres.2012.07.018","article-title":"Heparin infusion to prevent umbilical venous catheter related thrombosis in neonates","volume":"130","author":"Unal","year":"2012","journal-title":"Thromb. Res."},{"key":"ref_53","first-page":"CD000507","article-title":"Umbilical artery catheters in the newborn: Effects of heparin","volume":"1999","author":"Barrington","year":"2000","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Shah, P.S., and Shah, V.S. (2008). Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst. Rev., CD002772.","DOI":"10.1002\/14651858.CD002772.pub3"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e284","DOI":"10.1542\/peds.2006-0529","article-title":"A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: The HIP (Heparin Infusion for PCVC) study","volume":"119","author":"Shah","year":"2007","journal-title":"Pediatrics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1111\/j.1651-2227.2002.tb02833.x","article-title":"Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates","volume":"91","author":"Kamala","year":"2002","journal-title":"Acta Paediatr."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Shah, P.S., and Shah, N. (2014). Heparin-bonded catheters for prolonging the patency of central venous catheters in children. Cochrane Database Syst. Rev., CD005983.","DOI":"10.1002\/14651858.CD005983.pub3"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1038\/s41390-018-0082-0","article-title":"Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn","volume":"84","author":"Singh","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/s41390-018-0081-1","article-title":"The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock","volume":"84","author":"Nestaas","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41390-018-0075-z","article-title":"Application of Neonatologist Performed Echocardiography in the Assessment and Management of Neonatal Heart Failure unrelated to Congenital Heart Disease","volume":"84","author":"Levy","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/s41390-018-0077-x","article-title":"Application of NPE in the assessment of a patent ductus arteriosus","volume":"84","author":"Gupta","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_62","first-page":"843","article-title":"Incidental Findings on Routine Targeted Neonatal Echocardiography Performed in Preterm Neonates Younger Than 29 Weeks\u2019 Gestation","volume":"37","author":"Smith","year":"2018","journal-title":"J. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/4\/764\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:39:21Z","timestamp":1760121561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/4\/764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,17]]},"references-count":62,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13040764"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13040764","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,17]]}}}