Recombinant Activated Factor VII as a Hemostatic Agent in Very Low Birth Weight Preterms With Gastrointestinal Hemorrhage and Disseminated Intravascular Coagulation

Abstract

In this small group of preterms with DIC, intestinal hemorrhage, and persistent hemorrhagic shock, rFVIIa was effective as a rescue therapy but failed in patients with severe acidosis, hypothermia, and thrombopenia.

Successful use of recombinant factor VIIa in a preterm infant with life-threatening haematuria

“…To our knowledge, there are a few case reports and series describing off-label use of rFVIIa in nonhaemophiliac preterm infants for the treatment of severe haemorrhage of the lung [9-12], central nervous system [13,14], gastrointestinal tract [9,15], umbilicus [9,16], after traumatic delivery [17] or surgery due to necrotizing enterocolitis or malformations [9,12,[18][19][20][21][22]. In most cases (23 out of 31 patients), the treatment was effective, as haemorrhage was controlled or coagulation parameters were improved.…”

Disseminated Intravascular Coagulation in Term and Preterm Neonates

“…A DIC scoring system for very low birthweight preterms was developed in 1998. 38 Similar to the ISTH DIC score for adults, this neonatal score includes platelet 17 Necrotizing enterocolitis 22 Giant hemangioma (Kasabach-Merrit syndrome) 27 Respiratory distress syndrome 23,32 Obstetric complications 17 Liver dysfunction Hemangiomatosis 28 Amniotic fluid aspiration…”

“…72 However, in the clinical scenario of life-threatening hemorrhage (e.g., maternal postpartum hemorrhage complicated by DIC, neonatal necrotizing enterocolitis) the use of rFVIIa was described by others and us with varying success in achieving hemostasis. 22,[73][74][75] Our recommendation is to limit the use of rFVIIa to rescue attempts in scenarios of catastrophic acutely life-threatening hemorrhage in which conventional measures to achieve hemostasis have failed.…”