title: Is the use of rFVIIa safe and effective in bleeding neonates? A retrospective series of 8 cases.
abstract: BACKGROUND
  Recombinant activated factor VII (rFVIIa), originally developed for the treatment of life-threatening bleeding in hemophilic patients with inhibitors to factors VIII or IX, has been increasingly used to control hemorrhage unresponsive to conventional treatment, in the absence of a defined coagulopathy or thrombocytopathy. To date, clinical experience of rFVIIa administration in neonates, especially preterms, is rather limited, because of the lack of controlled studies and based solely on some published case reports and 1 prospective pilot study. The objective of this study was to retrospectively evaluate the clinical outcome of newborns treated with recombinant activated factor VII for intractable bleeding or severe coagulation disturbances, resistant to conventional hemostatic therapy.
  
  
  METHODS
  The medical records of 8 neonates treated with rFVIIa (100 micro g/kg) were retrospectively reviewed for the course of hemorrhage and the hemostatic interventions performed before and up to 24 hours after the administration rFVIIa. Coagulation parameters of 3 different time-points were assessed and compared: before administration of any blood product (time-point 1), before administration of the first dose of rFVIIa (time-point 2), and 4 hours after the administration of the last dose of rFVIIa (time-point 3). The safety and tolerability profile of rFVIIa in bleeding neonates was also evaluated.
  
  
  RESULTS
  Six preterm and 2 term patients were included in the study. Seven patients presented with refractory bleeding and 1 was diagnosed with severe coagulopathy unresponsive to the conventional treatment. Prompt hemostasis was achieved in half of the patients with their coagulation profile being restored within 4 hours after the administration of the first dose of rFVIIa. Improvement in prothrombin time, activated partial thromboplastin time, and fibrinogen after rFVIIa administration was statistically significant, as compared with that observed after conventional treatment. No major safety issues were observed during the study. All 8 patients survived and had their hemorrhage or coagulopathy controlled within 4 hours after transfusion of the last dose of rFVIIa.
  
  
  CONCLUSIONS
  In this study, the hemostatic agent rFVIIa was well-tolerated and behaved in a safe and efficacious manner in all infants treated for life-threatening bleeding and coagulation disorders. Future prospective controlled trials are needed to determine the efficacy, safety, tolerability, and possibly the optimal dose and timing of rFVIIa administration.
authors.affiliation: B' NICU and Neonatology Department of Aristotle University of Thessaloniki, Thessaloniki, Greece. mitsiakg@med.auth.gr
authors.forename: George
authors.initials: G
authors.lastname: Mitsiakos
authors.forename: Georgia
authors.initials: G
authors.lastname: Papaioannou
authors.forename: Evagelia
authors.initials: E
authors.lastname: Giougi
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Karagianni
authors.forename: Vassilia
authors.initials: V
authors.lastname: Garipidou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Nikolaidis
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001780:Blood Coagulation Tests; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D005167:Factor VII / Q000008:administration & dosage* / Q000009:adverse effects*; D015942:Factor VIIa; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020714:Maximum Tolerated Dose; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa