A newborn with a brain bleed and dangerous blood clot was successfully treated with heparin, according to a case report published recently in the American Journal of Perinatology Reports.
This successful treatment and recover could have implications for other infants experiencing brain bleeds due to fetal and neonatal alloimmune thrombocytopenia (FNAIT). FNAIT can lead to dangerously low platelet levels before or shortly after birth, making babies vulnerable to bleeding, including cranial hemorrhages.
What is FNAIT?
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but serious condition that affects 0.1% of pregnancies in which a pregnant mother’s immune system produces antibodies against the platelets of her fetus. This occurs when a fetus inherits platelet antigens from the father that are not compatible with the mother, typically involving a protein called human platelet antigen (HPA). The mother’s immune system recognizes the fetal platelets as foreign, attacking and destroying them, leading to low platelet levels (thrombocytopenia) in the fetus or newborn.
Despite initial concerns about bleeding, the clot resolved fully, the brain injury stabilized and the infant showed normal growth and near-normal neurologic development by 10 months of age.
In this case, a full-term male infant developed neurologic symptoms within hours of birth, including muscle weakness, abnormal limb movement and trouble feeding. Brain imaging revealed bleeding near the cerebellum and signs of cerebral sinus venous thrombosis—a rare but serious condition where blood clots form in the brain’s drainage system.
“[T]he American College of Chest Physicians stated that for neonates with CSVT [cerebral sinus venous thrombosis] without significant intraparenchymal hemorrhage, anticoagulation is suggested for a total duration between 6 weeks and 3 months,” explained the authors of this case study. “Faced with this controversy over the duration of treatment, we chose to be cautious with our patient and to extend the anticoagulant therapy until we had documented the complete recanalization of the venous sinuses by neuroimaging.”
Read more about FNAIT treatment and care
Doctors had to decide whether to prescribe an anticoagulant treatment such as heparin that could help keep the clot from worsening but might also increase bleeding. After confirming that the bleeding was stable through repeated ultrasounds, the care team began heparin at a low dose, then gradually increased it based on blood tests. Imaging over the following days showed the clot shrinking and no signs of new or worsening hemorrhage.
The baby improved steadily. By two weeks, he no longer needed breathing support. By one month, the brain scan showed almost complete healing of the clot and shrinking of the brain bleed. At seven months, the clot had fully resolved and doctors stopped the heparin. At 10 months, the child had grown well and showed only mild low muscle tone and slight eye movement issues related to vision processing.
There is little research and few guidelines available on management of cerebral sinus venous thrombosis in newborns with FNAIT-related bleeding. However, this case suggests that early, closely monitored use of heparin may offer more benefit than risk for some select patients.
Sign up here to get the latest news, perspectives, and information about FNAIT sent directly to your inbox. Registration is free and only takes a minute.
