Dalibor Šarić

Successful use of recombinant activated FVII and aminocaproic acid in four neonates with life-threatening hemorrhage.

Reports on the use of recombinant activated factor VII (rFVIIa) to counteract hemorrhagic shock in neonates and preterm infants are increasing. rFVIIa enhances thrombin generation in situations with impaired thrombin formation and, since thrombin has a crucial role in providing hemostasis, rFVIIa is regarded as a general hemostasis agent. Full thrombin generation is necessary for the formation of a stable fibrin plug resistant to premature fibrinolysis. Antifibrinolytic drugs are not recommended for the treatment of acute bleeding. We report four neonates (one with massive postsurgical hemorrhage after ileostomy and three with severe pulmonary hemorrhage in the course of mechanical ventilation for meconium aspiration syndrome, congenital heart disease and during postoperative resuscitation after cardiac surgery for congenital heart disease) who were successfully treated with multiple administration of rFVIIa (120 μg/kg per dose) and antifibrinolytic therapy — aminocaproic acid (100 mg/kg per dose). In a fibrinolytic environment therapeutic concentrations of rFVIIa may sometimes be insufficient to produce adequate amounts of thrombin necessary for stable clot structure. Laboratory data in three of our patients with pulmonary hemorrhage (low fibrinogen levels with slightly prolonged prothrombin time) supported this thesis, so we blocked fibrinolysis with aminocaproic acid and achieved a complete clinical and laboratory therapeutic effect.

Cardiopulmonary exercise performance is reduced in congenital diaphragmatic hernia survivors

Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia. CDH survivors may have pulmonary morbidity that can decrease cardiopulmonary exercise. We aimed to examine whether cardiopulmonary exercise testing (CPET) results differ in CDH survivors versus healthy age‐matched controls and whether CPET results among CDH survivors differ according to self‐reported daily activity.

Giant Mycotic Right Atrial Thrombus Due to Candida dubliniensis Septicemia in a Premature Infant

Rad opisuje slucaj ekstremne mikoticne tromboze desnog atrija u nedonosceta vrlo male rodne mase te izljecenje nakon trombektomije. U prilogu rada je i poveznica na ultrazvucni prikaz flotirajuceg tromba u desnom atriju.

Fatal infant nasal seawater spray instillation: Fatal infant nasal seawater spray instillation

The use of seawater nasal spray is considered safe and sold as a non‐prescription medicine. However, it is well known that nasal manipulations can provoke vagal reaction leading to acute life‐threatening events. A case of fatal seawater nasal spray application in an infant is presented.

Fatal infant nasal seawater spray instillation.

UNLABELLED The use of seawater nasal spray is considered safe and sold as a non-prescription medicine. However, it is well known that nasal manipulations can provoke vagal reaction leading to acute life-threatening events. A case of fatal seawater nasal spray application in an infant is presented. CONCLUSION We do not consider the use of seawater nasal spray to be absolutely safe, especially among infants with disordered autonomic function.