Recombinant human activated protein C for severe sepsis in a neonate

Abstract

Background: Neonatal sepsis is frequently associated with pathological activation of the coagulation system, leading to multiple organ dysfunction. Activated protein C has been shown to prevent thrombin generation during this process and improve microcirculation. Case report: We present the case of a full term septic neonate admitted for tertiary intensive care with multiple organ failure, including ARDS with severe pulmonary hypertension, renal failure, and disseminated intravascular coagulation. After initial resuscitation with volume expansion, catecholamines, pentoxifylline and nitric oxide, a diagnosis of severe systemic enteroccocal sepsis was made and vancomycin-meropenem therapy was started. Because available standard treatment, including platelet transfusion, did not improve the coagulation status, it was decided to give recombinant human activated protein C (drotrecogin alpha Xigris, Elli Lilly, USA -rhAPC) in 24 mcg kg-1.h-1 continuous four-day infusion. Six hours after the start of infusion all coagulation parameters returned to normal. No side effects were observed. Renal function was restored after 36-hr hemofiltration. Treatment success was due to several factors, including resuscitation from cardiogenic shock, effective antibiotic therapy, hemofiltration, and combined rhAPC-pentoxifylline therapy Conclusions: The positive outcome of this case indicates that rhAPC can be safely used in infants. A large-scale study of the effectiveness of drotrecogin alpha in pediatric population is indicated.