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

Abstract

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. This study was carried out retrospectively in premature infants with pulmonary hemorrhage that were ≤30weeks gestational age or <1250g 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 30min of pulmonary hemorrhage plus conventional treatment, while Group 2 (n=21) received conventional treatment only. The number of patients whose pulmonary hemorrhage was stopped within the first 2h 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±1.59g/dL; p=0.024). Erythrocyte suspension (1.43±4.51 vs 5.71±7.46mL/kg; p=0.030) and fresh frozen plasma use (5.71±8.10 vs 19.52±12.44mL/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 72h, 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. 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.