Use of Recombinant Activated Protein C in Therapy for Sepsis in Children after Cardiosurgical Interventions

Abstract

Sepsis is the principal cause of hospital death among children and ranks fourth among all causes of death in infants under 1 year of age and second in 1-to-14-year-old children. Objective: to assess whether activated protein C (APC) infusion may be incorporated into the complex intensive therapy for sepsis in babies of the first year of life. Subjects and methods. In January 2005 to April 2007, APC was used in the complex intensive therapy for sepsis in 36 infants of the first year of life. APC therapy was initiated in the first 24 hours after the occurrence of organ dysfunction in 29 (80%) patients and in the first 48 hours in others cases. Results. Status stabilization and multiple organ dysfunction (MOD) regression were noted in most patients during APC infusion. Ten (28%) patients died; mortality rates in the groups of patients with early and late infusion were 17 and 71%, respectively. The baseline APC level failed to affect 28-day survival. By the end of infusion, the mean level of protein C was much higher in the group of survivors than that in the deceased. Conclusion. APC as a part of the complex intensive therapy for sepsis should be given to infants of the first year of life who had multiple organ dysfunctions within the first 24 hours after the occurrence of organ dysfunction. Key words: pediatric sepsis, activated a-drotrecogin, multiple organ dysfunction.