Life-threatening hemorrhage in neonates: management with recombinant activated factor VII.
OBJECTIVE
Massive hemorrhage with shock is a common problem for the intensivist. The use of recombinant activated factor VII (rFVIIa), known as efficient treatment for hemophilia, has been reported to control severe bleeding episodes in critically care patients, but never in preterm neonates.


METHODS
Case report (two cases) and review of the literature.


METHODS
Neonatal intensive care unit, university teaching hospital.


METHODS
Two preterm neonates with life-threatening hemorrhages, from the liver and spleen in one patient and from the lung in the other.


METHODS
Intravenous administration of 150/200 microg/kg of rFVIIa (Novoseven, NovoNordisk, Copenhagen, Denmark).


RESULTS
Complete hemostasis 10 min after the second bolus in the two patients.


CONCLUSIONS
For the intensivist, the successful use of rFVIIa in these patients and others lacking pre-existing coagulopathies points to rFVIIa as a novel therapeutic approach for patients presenting with massive life-threatening hemorrhage.
Veldman
Alex
A
Department of Pediatrics, Division of Neonatalogy, J W Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. alex.veldman@kgu.de
Fischer
Doris
D
Voigt
Burkhard
B
Beyer
Peter A
PA
Schlösser
Rolf
R
Allendorf
Antje
A
Kreuz
Wolfhardt
W
D005167:Factor VII / Q000627:therapeutic use*; D017809:Fatal Outcome; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use*
D011994:Recombinant Proteins; D005167:Factor VII