Recombinant Activated Factor VIIa (rFVIIa) Treatment in Very-Low-Birth-Weight (VLBW) Premature Infants with Acute Pulmonary Hemorrhage: A Single-Center, Retrospective Study

• Published in: Paediatric drugs Vol. 19; no. 1; pp. 53 - 58
• Main Authors: Cosar, Hese, Isik, Halil, Cakır, Salih Cagrı, Yar, Nese, Goksen, Bulent, Tokbay, Hakan, Kertmen, Hasan, Erdoğan, Nihal, Durak, Ikbal
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2017; Springer Nature B.V
• Subjects: Acute Disease; Age; Babies; Birth weight; Blood products; Factor VIIa - therapeutic use; Female; Hemorrhage; Hemorrhage - drug therapy; Hemorrhage - mortality; Hospitalization; Humans; Infant, Premature; Infant, Very Low Birth Weight; Intensive care; Internal Medicine; Lung Diseases - drug therapy; Lung Diseases - mortality; Lungs; Male; Medicine; Medicine & Public Health; Mortality; Newborn babies; Original Research Article; Patients; Pediatrics; Pharmacotherapy; Premature Birth; Recombinant Proteins - therapeutic use; Recurrence; Retrospective Studies; Risk factors; Surfactants; Ventilators; International Normalize Ratio; Pulmonary Hemorrhage; Premature Infant; Patent Ductus Arteriosus; Fresh Freeze Plasma
• ISSN: 1174-5878; 1179-2019
• DOI: 10.1007/s40272-016-0203-3

Aim We aimed to evaluate the efficacy of intravenous administration of recombinant activated factor VIIa (rFVIIa) for acute pulmonary hemorrhage treatment in very-low-birth-weight (VLBW) premature infants. Patients and Methods This study was carried out retrospectively in premature infants with pulmonary hemorrhage that were ≤30 weeks gestational age or <1250 g birth weight. The data of all VLBW premature infants with pulmonary hemorrhage who were hospitalized in our neonatal intensive care unit between 01 January 2013 and 31 December 2015 were evaluated. Group 1 ( n  = 21) received rFVIIa support within the first 30 min of pulmonary hemorrhage plus conventional treatment, while Group 2 ( n  = 21) received conventional treatment only. Results The number of patients whose pulmonary hemorrhage was stopped within the first 2 h was significantly higher in Group 1 than Group 2 ( n  = 14 vs n  = 4; p  = 0.002). After pulmonary hemorrhage, hemoglobin values of Group 1 were higher than Group 2 (11.12 ± 1.06 vs 10.14 ± 1.59 g/dL; p  = 0.024). Erythrocyte suspension (1.43 ± 4.51 vs 5.71 ± 7.46 mL/kg; p  = 0.030) and fresh frozen plasma use (5.71 ± 8.10 vs 19.52 ± 12.44 mL/kg; p  < 0.001) in Group 1 were lower than those of Group 2. Prothrombin time, activated partial thromboplastin time, and international normalized ratio values in Group 1 were lower than those of Group 2 ( p  < 0.05). No statistically significant difference was identified in recurrence of pulmonary hemorrhage after 72 h, overall mortality, mortality from pulmonary hemorrhage, surfactant use, intubation time, hospitalization duration, intraventricular hemorrhage (IVH), severe IVH, patent ductus arteriosus rates, or short-term complication rates. Conclusion rFVIIa administration was observed to be effective in stopping pulmonary hemorrhage, reducing blood product requirement, and improving coagulation test parameters. Prospective studies are needed to evaluate the efficacy, reliability, and long-term results of rFVIIa in the prevention and treatment of pulmonary hemorrhage in premature infants.