Life-threatening hemorrhage in neonates: management with recombinant activated factor VII.

OBJECTIVE: Massive hemorrhage with shock is a common problem for the intensivist. The use of recombinant activated factor VII (rFVIIa), known as efficient treatment for hemophilia, has been reported to control severe bleeding episodes in critically care patients, but never in preterm neonates. DESIGN: Case report (two cases) and review of the literature. SETTING: Neonatal intensive care unit, university teaching hospital. PATIENTS: Two preterm neonates with life-threatening hemorrhages, from the liver and spleen in one patient and from the lung in the other. INTERVENTION: Intravenous administration of 150/200 microg/kg of rFVIIa (Novoseven, NovoNordisk, Copenhagen, Denmark). MEASUREMENTS AND RESULTS: Complete hemostasis 10 min after the second bolus in the two patients. CONCLUSION: For the intensivist, the successful use of rFVIIa in these patients and others lacking pre-existing coagulopathies points to rFVIIa as a novel therapeutic approach for patients presenting with massive life-threatening hemorrhage.

A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children.

BACKGROUND: It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children. METHODS: The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy. RESULTS: No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 +/- 7.5 vs 34.6 +/- 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 +/- 8.7 vs 20.2 +/- 5.3 minutes, P < .05). CONCLUSION: At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.