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Recombinant activated factor VIIa treatment for refractory hemorrhage in infants

Journal of Perinatology volume 31, pages 188–192 (2011)Cite this article

Subjects

Abstract

Objective:

Report clinical response to recombinant factor VIIa in a cohort of critically ill infants.

Study Design:

We identified all infants who received factor VIIa in the Duke Neonatal Intensive Care Unit between January 2005 and July 2008. Hematological data and volume of blood transfusions before and after factor VIIa treatment were compared. The precipitating diagnosis for each factor VIIa use, and the ensuing clinical outcomes of bleeding, thrombosis and mortality were noted.

Result:

We identified 18 infants with median birth weight of 880 g and median gestational age of 26 weeks. One to six doses of factor VIIa (90 mcg kg−1 per dose) were administered, with 13 (72%) infants receiving a single dose. Hemostasis was achieved in 13 (72%) of the infants. Prothrombin time and activated partial thromboplastin time significantly decreased following treatment with factor VIIa. Volume of plasma transfusions significantly decreased following treatment with factor VIIa (P=0.02). Thrombosis occurred in one (11%) infant. Six (33%) infants died within 72 h of treatment, and overall mortality was 10/18 (56%).

Conclusion:

Treatment with factor VIIa at doses of 90 mcg kg−1 improved coagulation studies and decreased the need for plasma transfusions in a group of critically ill infants without significant risk. Factor VIIa may be an effective addition to current treatment modalities for refractory hemorrhage in infants.

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Acknowledgements

We thank Kimberley A Fisher, RN, PhD and Sandra Grimes, RN for their expert technical contributions. The Jean and George W Brumley, Jr Neonatal Perinatal Research Institute provided financial support for this study. Dr Smith received support from NIH-1K23HD060040-01.

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Authors and Affiliations

  1. Department of Pharmacy, Duke University Medical Center, Durham, NC, USA

    C N Dang

  2. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    L I Katakam, P B Smith, C M Cotten, R N Goldberg, N Chandler, C D Thornburg & M Bidegain

  3. Jean and George W. Brumley Jr. Neonatal-Perinatal Research Institute, Durham, NC, USA

    L I Katakam, P B Smith, C M Cotten, R N Goldberg & M Bidegain

  4. Duke Clinical Research Institute, Durham, NC, USA

    P B Smith

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  1. C N Dang
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  2. L I Katakam
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Correspondence to M Bidegain.

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Dang, C., Katakam, L., Smith, P. et al. Recombinant activated factor VIIa treatment for refractory hemorrhage in infants. J Perinatol 31, 188–192 (2011). https://doi.org/10.1038/jp.2010.85

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