Recombinant factor VIIa for treatment of massive liver fracture in a premature infant

Recombinant factor VIIa (rFVIIa) is a highly efficacious therapy initially used to treat the bleeding diathesis of hemophiliac patients that has recently gained a wider role in the treatment of liver disease, thrombocytopenia, and intracerebral and traumatic hemorrhage. Data with regard to the use of rFVIIa within the pediatric population for the treatment of liver injury, however, are limited. We present a case report of successful treatment using rFVIIa of an iatrogenic liver injury in a 1200-g infant who was undergoing resection of a large sacrococcygeal teratoma. In addition, we review the issues of surgical relevance to the pediatric surgeon relating to rFVIIa's mechanism of action and dosages for clinical application.