Acute myocardial infarction in a premature infant on the first day of life

Neonatal myocardial infarction (MI) is a very rare but potentially life-threatening condition with an approximated mortality rate of 80%. Congenital heart disease, anomalous coronary artery anatomy, thromboembolism, coagulopathy, birth asphyxia or myocarditis have been suggested as possible causes of MI. Here we report the case of a premature infant who died at about 40 h of life from a massive MI. Autopsy revealed an occlusive thrombus in the right coronary artery. An isolated prothrombotic status, characterized by a double copy variant of the MTHFR A1298C mutation, was identified at the postmortem genetic studies as a possible explanation for the coronary artery thrombosis. No other risk factors were detected.