Right atrial thrombus in neonates following hyperosmolar glucose infusion: A case series

Abstract

Background

Cardiac thrombus in neonates is an uncommon but life-threatening condition that may result in significant morbidity and mortality. Factors such as invasive procedures, metabolic disturbances, and the use of high-osmolarity fluids can contribute to thrombus formation, particularly in critically ill neonates. This case series aims to highlight the clinical characteristics, potential risk factors, and outcomes of right atrial thrombus in neonates, with particular emphasis on the role of high-concentration glucose infusions administered through umbilical venous catheters.

Methods

This is a retrospective case series of five neonates who developed right atrial thrombus between January 2022 and December 2024.

Results

All five neonates have a history of receiving high-concentration glucose infusions via umbilical venous catheters for hyperinsulinemic hypoglycemia before the development of right atrial thrombus. Unexplained tachycardia prompted the diagnosis, with echocardiography revealing thrombi. Three of them were successfully treated with anticoagulation, while the other two babies unfortunately succumbed to complications despite intensive treatment.

Conclusion

Large cardiac thrombus in neonates leads to high mortality due to the risk of embolization and sepsis. High-concentration glucose infusion via umbilical venous catheter is a potential risk factor for cardiac thrombus formation in neonates. Early detection and appropriate intervention, including anticoagulation and thrombolysis, are crucial for preventing further complications and improving survival rates.