Management of coagulopathy with recombinant factor VIIa in a neonate with echovirus type 7.
A 5-day-old newborn presented with neonatal enteroviral infection. The patient's hospital course was complicated by acute liver dysfunction, renal insufficiency, fluid overload, respiratory failure, hypertension, catheter related thrombosis, Klebsiella pneumoniae sepsis, intracerebral and intraventricular hemorrhage, and disseminated intravascular coagulation (DIC). Administration of fresh frozen plasma (FFP) and cryoprecipitate failed to control the patient's hemostasis and led to significant fluid overload. Recombinant activated factor VII (rFVIIa, Novoseven NovoNordisk, Bagsvaerd, Denmark) was given to the neonate as a bolus (rFVIIa at 60-80 microg/kg body weight), followed by a continuous infusion (2.5-16 microg/kg/hr). Recombinant activated factor VII controlled hemostasis, until the patient's liver function recovered. The patient's blood product requirement significantly decreased and his fluid overload resolved. Administration of rFVIIa appears to have stabilized the coagulation process. The patient appears to have fully recovered from the infection's complications.
Tancabelic
Jakica
J
University of South Dakota School of Medicine, Department of Pediatrics, Pediatric Critical Care Medicine, Sioux Falls, South Dakota 57117, USA. jtancabe@usd.edu
Haun
Steven Edward
SE
D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D029822:Enterovirus B, Human; D004769:Enterovirus Infections / Q000150:complications*; D015942:Factor VIIa / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008297:Male; D011994:Recombinant Proteins; D014057:Tomography, X-Ray Computed
D011994:Recombinant Proteins; D015942:Factor VIIa