Successful Intraluminal Administration of Tissue Plasminogen Activator for Life-Threatening Obstructive Hematoma in Extremely Preterm Infants

We report the cases of two extremely preterm infants who were successfully treated with tissue plasminogen activator (tPA) for a life-threatening obstructive intraluminal hematoma. One infant presented with bowel perforation and ileus resulting from a gastrointestinal (GI) hematoma, whereas the other experienced lung collapse due to an intratracheal hematoma. Direct administration of tPA to the GI tract and trachea, respectively, resulted in hematoma lysis and relief of the obstruction. For extremely preterm infants with limited viable treatment options, local tPA may be a valuable approach for managing severe obstructive intraluminal hematomas that lead to GI obstruction or lung collapse.