Etiology of Hemoptysis in Children and Adolescents – Multicentric Retrospective Data (2012-2021) From Chennai

Objective: To analyze the etiology of hemoptysis in children and to correlate the severity of bleed with the etiology. Methods: This retrospective multicentre study reviewed data from inpatient units of four tertiary care public and private sector pediatric hospitals in Tamil Nadu. Methods: Inpatient case records of children (aged 2 month-15 years) treated for hemoptysis at the four institutions between April, 2012 and March, 2021 were identified, after ethical clearance from respective institutions. Data of children with underlying known bleeding disorders like hemophilia or platelet abnormality were excluded from the study. Hemoptysis was categorized as mild, moderate and severe Results: Of the 73 children who had presented with hemoptysis during the study period, 60 (82.2%) children had mild, 9 (12.3%) had moderate and rest had severe hemoptysis. Idiopathic pulmonary hemorrhage was the most common cause of hemoptysis. The common causes of mild hemoptysis in children were idiopathic pulmonary hemorrhage (n=15, 25%), pulmonary tuberculosis (n=12, 20%) and pneumonia (n=8, 13.3%). Congenital airway anomalies and vascular anomalies were more likely to present with moderate to severe bleed. Conclusion: Etiology of hemoptysis is broad and categorizing them into mild, moderate and severe may give a clue about the possible etiology, there by restricting to the required investigations.

Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.@*METHODS@#A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants.@*RESULTS@#The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (P<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (P<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%CI: 0.802-0.944, P<0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%.@*CONCLUSIONS@#Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.

Risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants / 国际儿科学杂志

Objective:To analyze the risk factors of pulmonary hemorrhage in very low and extremely low birth weight, and to provide reference for the treatment of pulmonary hemorrhage.Methods:The clinical data of very low and extremely low birth weight infants hospitalized in Qingdao Women and Children′s Hospital NICU from January 2017 to December 2021 were retrospectively analyzed.Eighty-six infants who were diagnosed with pulmonary hemorrhage were selected as the pulmonary hemorrhage group, and two hundred and two infants without pulmonary hemorrhage were selected as the control group.The differences of the survival rates, complications and parameters of platelet between the two groups were compared, and the risk factors of pulmonary hemorrhage by multivariate Logistic regression were analyzed.Results:The survival rate of pulmonary hemorrhage group and control group were 65.1%(56/86) and 90.1%(182/202), respectively.The survival rate of control group was significantly higher than that in the pulmonary hemorrhage group( χ2=26.241, P<0.01). There was no significant difference in fluid intake between the two groups within three days after birth( t=0.936, 1.811, 1.840, P=0.350, 0.073, 0.069). The multivariate Logistic regression analysis showed hemodynamically significant patent ductus arteriosus( OR=2.304, 95% CI: 0.213~1.564, P=0.010), disseminated intravascular coagulation( OR=3.143, 95% CI: 0.061~2.521, P=0.028), thrombocytopenia( OR=0.991, 95% CI: -0.015~-0.005, P=0.001) and low mean platelet volume( OR=0.337, 95% CI: -1.657~-0.739, P=0.001) were the risk factors of pulmonary hemorrhage. Conclusion:Hemodynamically significant patent ductus arteriosus, disseminated intravascular coagulation, thrombocytopenia and low mean platelet volume were associated with increased risks for pulmonary hemorrhage in very low and extremely low birth weight.These risk factors should be actively monitored and treated, which is helpful to early identify and prevent pulmonary hemorrhage.

Pulmonary involvement from animal toxins: the cellular mechanisms

Abstract Venomous animals and their venom have always been of human interest because, despite species differences, coevolution has made them capable of targeting key physiological components of our bodies. Respiratory failure from lung injury is one of the serious consequences of envenomation, and the underlying mechanisms are rarely discussed. This review aims to demonstrate how toxins affect the pulmonary system through various biological pathways. Herein, we propose the common underlying cellular mechanisms of toxin-induced lung injury: interference with normal cell function and integrity, disruption of normal vascular function, and provocation of excessive inflammation. Viperid snakebites are the leading cause of envenomation-induced lung injury, followed by other terrestrial venomous animals such as scorpions, spiders, and centipedes. Marine species, particularly jellyfish, can also inflict such injury. Common pulmonary manifestations include pulmonary edema, pulmonary hemorrhage, and exudative infiltration. Severe envenomation can result in acute respiratory distress syndrome. Pulmonary involvement suggests severe envenomation, thus recognizing these mechanisms and manifestations can aid physicians in providing appropriate treatment.

Clinical features and risk factors of pulmonary hemorrhage in extremely preterm infants / 中国新生儿科杂志

Objective:To study the clinical features and risk factors of pulmonary hemorrhage in extremely preterm (EPT) infants.Methods:From February 2018 to January 2022, EPT infants admitted to NICU of our hospital and diagnosed with pulmonary hemorrhage were retrospectively assigned into the observation group and those without pulmonary hemorrhage were assigned into the control group. Univariate analysis and multivariate logistic regression analysis were used to compare the clinical features and determine risk factors of pulmonary hemorrhage in EPT infants.Results:A total of 114 EPT infants were included, including 28 cases (24.6%) in the observation group with pulmonary hemorrhage and 86 cases in the control group. Pulmonary hemorrhage mainly occurred within the first week after birth. Univariate analysis showed that the observation group had higher incidences of following events than the control group: birth asphyxia, delivery room intubation, severe respiratory distress syndrome, hyperglycemia, thrombocytopenia, severe acidosis, shock, score for neonatal acute physiology with perinatal extension-Ⅱ (SNAPPE-Ⅱ) ≥37 and the highest lactate level. Birth weight was lower in the observation group than the control group ( P<0.05). Logistic regression analysis showed that SNAPPE-Ⅱ≥37, shock and hyperglycemia were risk factors of pulmonary hemorrhage ( OR=4.081, 4.610 and 3.355, respectively, all P<0.05). The incidences of mortality and intracranial hemorrhage in the observation group were higher than the control group. The duration of mechanical ventilation in the observation group was longer than the control group ( P<0.05). No significant differences existed in the duration of nasal continuous positive airway pressure, assist mechanical ventilation and total oxygen use, the incidences of grade Ⅱ-Ⅲ bronchopulmonary dysplasia, retinopathy of prematurity and the length of hospital stay ( P>0.05). Conclusions:SNAPPE-Ⅱ≥37, shock and hyperglycemia are early risk factors for pulmonary hemorrhage in EPT infants. EPT infants with pulmonary hemorrhage have higher incidences of mortality and intracranial hemorrhage, requiring longer periods of mechanical ventilation.

Hemosiderosis pulmonar idiopática, caso clínico en México. Importancia de un diagnóstico y tratamiento oportuno / Idiopathic pulmonary hemosiderosis, clinical case in Mexico. The relevance of performed an early diagnosis and treatment

La hemosiderosis pulmonar idiopática (HPI) es una patología poco frecuente; su distribución geográfica, su incidencia y prevalencia se desconocen de manera exacta a nivel mundial. Tiene una fuerte asociación con condiciones autoinmunes y una adecuada respuesta al tratamiento inmunosupresor. A pesar de ser una patología grave, presenta una tasa de morbilidad y mortalidad mediana, siempre que se realice un diagnóstico y tratamiento precoz. Se presenta el caso clínico de una paciente femenina con diagnóstico de HPI quien cursó con la triada clásica de esta enfermedad: hemoptisis, anemia ferropénica e infiltrados pulmonares difusos. Se descartaron otras causas de hemorragia pulmonar difusa y se realizó el diagnóstico por biopsia pulmonar. Se trató con esteroides sistémicos e inhalados y azatioprina. Tras casi 2 años después del diagnóstico, estando sin tratamiento por 3 meses, presentó una exacerbación con hemorragia pulmonar masiva ocasionando el fallecimiento de la paciente.

Idiopathic pulmonary hemosiderosis (IPH) is a rare pathology; its geographic distribution, incidence and prevalence are not accurately known worldwide. It has a strong association with autoimmune conditions and has an adequate response to immunosuppressive treatment. Despite being a serious pathology, it has a medium morbidity and mortality rate, provided that early diagnosis and treatment is performed. We present the clinical case of a female patient diagnosed with IPH who presented with the classic triad of this disease: hemoptysis, iron deficiency anemia and diffuse pulmonary infiltrates. Other causes of diffuse pulmonary hemorrhage were ruled out and the diagnosis was made by lung biopsy. She was managed with systemic and inhaled steroids and azathioprine. After almost 2 years before the diagnosis, being without treatment for 3 month she had a massive pulmonary hemorrhage, causing the death of the patient.

Diffuse alveolar hemorrhage complicating dengue haemorrhagic fever in a 15-year-old boy: A case report

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

Síndrome pulmón-riñón en pacientes con hallazgos incidentales de agentes infecciosos / Pulmonary-renal syndrome in patients with incidental findings of infectious agents

El síndrome pulmón-riñón (SPR) o síndrome reno-pulmonar es la combinación de glomerulonefritis aguda rápidamente progresiva (GNARP) y hemorragia alveolar difusa (HAD) de causa autoinmune. El SPR fue inicialmente descrito por Goodpasture en el contexto del síndrome anti-membrana basal glomerular (MBG). Actualmente, las vasculitis asociadas a ANCA (VAA) explican el 60% (rango 56­77.5%) de casos, el síndrome de Goodpasture el 15% (12.5­17.5%), y un 10% de casos se deben a otras causas. El SPR presenta un gran espectro clínico, desde la capilaritis pulmonar fulminante con HAD y falla respiratoria aguda, hasta formas más sutiles de enfermedad sólo detectables mediante lavado bronquio-alveolar (LBA). El objetivo de este estudio es presentar la primera serie peruana de SPR asociada a agentes infecciosos. Reportamos 3 casos, dos correspondieron a lupus eritematoso sistémico y uno a vasculitis asociada a poliangeítis microscópica. El primer caso se asoció a sobreinfección por C. tropicalis; el segundo caso a A. fumigatus y C. albicans; y el tercero a infestación por A. lumbricoides. Todos los casos se presentaron en mujeres, requirieron soporte ventilatorio invasivo y hemodiálisis, y dos resultaron letales. Concluimos que, el SPR es una condición clínica grave comúnmente asociada a sobreinfecciones o infestaciones, y que conlleva una elevada morbilidad y mortalidad. Puesto que no existen características clínicas específicas, resulta crucial tener un alto índice de sospecha. Las investigaciones pertinentes­pruebas inmunológicas, imagenológicas, y biopsia cutánea, renal y/o pulmonar­para precisar la etiología deben realizarse sin demora ya que el tratamiento precoz puede cambiar el pronóstico de estos pacientes(AU)

Pulmonary-renal syndrome (PRS) or reno-pulmonary syndrome is the combination of acute rapidly progressive glomerulonephritis (RPGNARP) and autoimmune diffuse alveolar hemorrhage (DAH). RPS was initially described by Goodpasture in the context of anti-glomerular basement membrane (GBM) syndrome. Currently, ANCA-associated vasculitides (AAV) explain 60% (range 56­77.5%) of cases, Goodpasture syndrome 15% (12.5­17.5%), and 10% of cases are due to other causes. PRS presents a wide clinical spectrum, from fulminant pulmonary capillaritis with ADH and acute respiratory failure, to subtler forms of disease that can only be detected by bronchoalveolar lavage (BAL). The objective of this study is to present the first Peruvian series of SPR associated with infectious agents. We report 3 cases, two corresponded to systemic lupus erythematosus and one to vasculitis associated with microscopic polyangiitis. The first case was associated with superinfection by C. tropicalis; the second case to A. fumigatus and C. albicans; and the third to infestation by A. lumbricoides. All cases occurred in women, required invasive ventilatory support and haemodialysis, and two were fatal. We conclude that SPR is a serious clinical condition commonly associated with superinfections or infestations, and that it carries high morbidity and mortality. Since there are no specific clinical features, a high index of suspicion is crucial. Relevant investigations­immunological tests, imaging tests, and skin, kidney, and/or lung biopsies­to specify the etiology should be carried out without delay, since early treatment can change the prognosis of these patients(AU)

Pulmonary hemorrhage in dengue: differential diagnosis with acute viral respiratory syndromes including COVID-19

ABSTRACT Clinical similarities among viral diseases become even more relevant considering the current scenario, especially in Brazil, where there is a high incidence of these diseases and overlapping seasonality. We report the case of a patient with acute clinical manifestations composed of predominant respiratory symptoms and alveolar hemorrhage in which three etiologies (dengue, influenza and COVID-19) were investigated concomitantly. Only the diagnosis of dengue was confirmed. Then, the patient's immunological profile in response to stimulation of mononuclear cells with dengue virus antigen was analyzed in an attempt to identify specific characteristics that could be associated with the clinical manifestation.

Nuevos factores de riesgo de hemorragia pulmonar que complican la biopsia pulmonar guiada por TC en técnica coaxial / Novel risk factors of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial technique

Objetivos: Evaluar la frecuencia y gravedad de la hemorragia parenquimatosa pulmonar tras la biopsia pulmonar con aguja transtorácica coaxial, según factores de procedimiento, aún no descritos en la literatura. El objetivo de este estudio fue determinar si la elección de la tecnología de biopsia coaxial, el posicionamiento del paciente y la dignidad de la lesión son tres nuevas variables que influyen en el riesgo de hemorragia parenquimatosa tras biopsias coaxiales de pulmón. Métodos: Se revisaron retrospectivamente los registros de 117 pacientes que se sometieron a biopsias con aguja transtorácica del pulmón entre enero de 2018 y abril de 2020. El resultado primario fue la hemorragia pulmonar. Se ha utilizado un sistema de clasificación para clasificar la hemorragia parenquimatosa pulmonar: Grado 0 - Grado 3. Se evaluaron tres variables novedosas relacionadas con el paciente, la técnica y la lesión como predictores de hemorragia pulmonar: tecnología de biopsia coaxial, posición del paciente y dignidad de la lesión. Resultados: De los 117 pacientes, 18 (15,4%) pacientes con tecnología de biopsia coaxial de corte, versus 29 (24,8%) pacientes con tecnología coaxial de núcleo completo mostraron hemorragia significativa en las exploraciones de control posteriores a la biopsia. (IC del 95% 0,06-0,33, p <0,0001). No hubo diferencias significativas en la hemorragia pulmonar entre el diagnóstico histológico benigno y maligno (IC 95% 0,84-4,44, p = 0,1199) y la posición del paciente en decúbito prono o supino (IC 95%: 0,57-2,57, p = 0,6232). Conclusiones: La incidencia y gravedad de la hemorragia pulmonar depende de la tecnología de biopsia coaxial utilizada; siendo mayor en pacientes sometidos a una biopsia con tecnología full-core y menor después del uso de tecnología de corte. En este estudio de pronóstico no se estableció una correlación significativa entre la hemorragia pulmonar parenquimatosa y la posición del paciente o la dignidad de la lesión

Objectives: To evaluate the frequency and severity of pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors, not yet described in literature. The aim of this study was to determine whether the choice of the coaxial biopsy technology, patient positioning and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung. Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 ­ Grade 3. Three novel patient, technique and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning and lesion dignity. Results: Out of the 117 patients, 18 (15,4%) patients with cutting coaxial biopsy technology, versus 29 (24,8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans. (95% CI 0,06-0,33, p<0,0001). No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI 0,84-4,44, p=0,1199) and prone or supine patient positioning (95% CI: 0,57-2,57, p= 0,6232) was found. Conclusions: The incidence and severity of pulmonary hemorrhage depends on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.

Development of a predictive model of pulmonary hemorrhage in patients after CT-guided coaxial core needle lung biopsy / 西安交通大学学报(医学版)

【Objective】 To establish a predictive model for patients with hemorrhage after CT-guided coaxial core needle lung biopsy （CCNB） based on logistic regression. 【Methods】 A total of 489 patients who had undergone CCNB were retrospectively recruited. The potential risk factors of hemorrhage after lung biopsy were analyzed by univariate and multivariate logistic regression， through which we screened the independent risk factors and established a prediction model for hemorrhage. We evaluated the discrimination， calibration and clinical usefulness of the model. 【Results】 There were 141 cases （42.6%） of hemorrhage in the development group and 66 cases （41.8%） of hemorrhage in the validation group； there was no case of severe hemorrhage or hemothorax. Multivariate logistic regression analysis showed that fibrinogen degradation products， pulmonary interstitial fibrosis， largest diameter and puncture depth were independent predictive factors of hemorrhage. Hemorrhage prediction model was established and presented in the form of a nomogram. Discrimination of the model： the AUC was 0.837 in the development group and 0.777 in the validation group. The calibration curve showed good agreement between predicted probability and actual probability of hemorrhage. The unreliability test yielded a P value of 0.849 in the development group and 0.147 in the validation group. The DCA curve showed that the hemorrhage predictive model could increase the benefit of patients. 【Conclusion】 The predictive model of hemorrhage in patients after CCNB based on logistic regression can be used in clinical practice.

Hemorragia alveolar por montelukast: reporte de caso / Montelukast-induced alveolar hemorrhage: report of a case

RESUMEN La hemorragia alveolar difusa es un hallazgo clínico patológico, consecuencia de una lesión en la microcirculación pulmonar que se presenta con sintomatología inespecífica e incluso en pacientes asintomáticos. Se diferencian tres diagnósticos histopatológicos, siendo la capilaritis el más común y secundario a patologías autoinmunes. Se presenta el caso de un paciente, con hallazgo imagenológico y en lavado broncoalveolar, compatible con hemorragia alveolar difusa en quien se descartó como causa, enfermedades autoinmunes e infecciosas; durante la anamnesis, se identificó inicio reciente de montelukast, con relación temporal, respuesta a suspensión, cambio imagenológico y escalas de probabilidad de reacción adversa de Naranjo que apoya el diagnóstico.

ABSTRACT Diffuse alveolar hemorrhage is a pathological finding, defined as a consequence of a lesion in pulmonary microcirculation which occurs with non-specific symptoms, and sometimes it may show no symptoms. Three histopathological diagnoses are to be differentiated. The most common is capillary inflammation, which is secondary to autoimmune conditions. We present the case of a patient with image studies and bronchoalveolar lavage compatible with diffuse alveolar hemorrhage, in whom autoimmune and infectious causes were ruled out. The history of the patient indicated recent use of montelukast, being this time-related with the patient's clinical condition. The patient responded when the drug was withheld, image studies showed particular findings, and results in the Naranjo ADR scale supported the diagnosis.

Efficacy of sequential heated humidified high flow nasal cannula after extubation in premature infants with pulmonary hemorrhage / 中华实用儿科临床杂志

Objective@#To investigate the clinical efficacy of sequential heated humidified high flow nasal ca-nnula(HHHFNC)after extubation in premature infants with pulmonary hemorrhage.@*Methods@#A total of 52 premature infants with pulmonary hemorrhage were selected, who were randomly (by means of random number table) given nasal intermittent positive pressure ventilation(NIPPV)(27 cases) and HHHFNC (25 cases) as a sequential respiratory su-pport from January 2017 to January 2018 at Suzhou Hospital of Nanjing Medical University were selected.The incidence of the basic conditions of the 2 groups of premature infants [gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of nitric oxide(NO)], blood gas analysis indicators at 1 h before extubation and ventilator parameters including the arterial oxygen partial pressure [pa(O2)], arterial partial pressure of carbon dioxide [pa(CO2)], pH value, positive end-expiratory pressure(PEEP), respiratory rates (RR), peak inspiratory pressure (PIP), fraction of inspiration oxygen (FiO2) were compared.The blood gas analysis after extubation [pa(O2), pa(CO2), pH value] at 1 h, outcome events/complications at the end of treatment (reintubation, uration of oxygen therapy after pulmonary hemorrhage, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax) were also compared.@*Results@#There were no significant differences between the NIPPV group and the HHHFNC group in the following items: gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of NO[(30.5±2.9) weeks vs.(31.6±2.7) weeks, 1 325(818) g vs.1 400(800) g, 5 days vs.4 days, 25.9%(7/27 cases) vs.24.0%(6/25 cases), 7.4%(2/27 cases)vs.0(0/25 cases), all P>0.05]. There were no significant differences between the two groups in blood gas analysis indicators before extubation at 1 h and ventilator parameters [pa(O2), pa(CO2), pH value, PEEP, RR, PIP, FiO2], blood gas analysis [pa(O2), pa(CO2), pH value] after extubation at 1 h (all P>0.05); There were no significant differences between the two groups in reintubation, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax [7.4%(2/27 cases) vs.4.0%(1/25 cases), 43(29) days vs.41(22) days, 40.7%(11/27 cases ) vs.16.0%(4/25 cases), 11.1%(3/27 cases) vs.12.0%(3/25 cases), 37.0%(10/27 cases) vs.32.0%(8/25 cases), 7.4%(2/27 cases ) vs.12.0%(3/25 cases), 7.4%(2/27 cases) vs.12.0%(3/25 cases)] (all P>0.05). The duration of oxygen therapy after pulmonary hemorrhage in the HHHFNC group was shorter than that in the NIPPV group [25(30) days vs.9(22) days, P<0.05].@*Conclusions@#As a sequential respiratory support for preterm infants with pulmonary hemorrhage, HHHFNC has shorter duration of oxygen therapy after pulmonary hemorrhage than that of NIPPV, suggesting that HHHFNC is an ideal non-invasive ventilation treatment.

Clinical features of pulmonary hemorrhage in children at pediatric intensive care unit / 中华实用儿科临床杂志

Objective@#To investigate the epidemiology and clinical features of pulmonary hemorrhage in children at pediatric intensive care unit(PICU).@*Methods@#A retrospective cohort case analysis was performed in order to investigate the incidence, primary disease, clinical manifestations and clinical characteristics of pulmonary hemorrhage in children at PICU of Shengjing Hospital of China Medical University from January 2008 to September 2017.@*Results@#Among the 73 cases, 39 cases were male (53.4%) and 34 cases were female(46.6%), and the average age was 31(5, 72)months.The conditions of 14 cases(19.2%) were improved and discharged, 17(23.3%) cases died during the hospitalization period, and 42 cases gave up treatment halfway.The primary causes of pulmonary hemorrhage included severe heart failure in 17 patients (23.3%), acute respiratory distress syndrome (ARDS) in 12 patients (16.4%), severe sepsis in 10 patients (13.7%), hematological diseases in 10 patients (13.7%), intracranial hemorrhage occurred in 5 patients (6.8%), cardiac arrest in 5 patients (6.8%), coagulation dysfunction in 5 patients(6.8%), renal disease in 3 patients(4.2%) and other diseases in 6 patients(8.3%). The symptoms of all cases (73 cases) of pulmonary hemorrhage included dyspnea, moist rales and decreased blood oxygen saturation.Nasal bleeding or coffee ground like material drawn out from nasal stomach tube could be found in 32 cases(43.8%, 32/73 cases), 36 cases(49.3%, 36/73 cases)were complicated by shock and 9 cases (12.3%, 9/73 cases) were combined with convulsions, and 47 cases (64.4%, 47/73 cases) were given cardiopulmonary resuscitation.The positive end expiratory pressure in ARDS group was(10.2±2.4) cmH2O(1 cmH2O=0.098 kPa), which was higher than that in other groups (F=4.59, P<0.01). The oxygen concentration in acute respiratory distress syndrome group was(0.9±0.1)% , which was higher than that in other groups (F=3.16, P<0.01). International normalization ratio was 1.9±0.7 in severe sepsis group, which was higher than that in other groups (F=2.96, P<0.01). Blood platelets in hematological disease group was (52.0±46.8)×109/L, which was lower than that in other groups (F=8.23, P<0.01) and hemoglobin in hematological disease group was (81.6±15.6) g/L, which was lower than that in other groups (F=5.48, P<0.01). Chest X-ray examinations showed decreased lung permeability, multiple exudative lesions in 61 cases and increased bronchovascular shadows in 5 cases.@*Conclusions@#Pulmonary hemorrhage may be a complication of many diseases. Severe heart failure, ARDS, severe sepsis and hematological diseases are the first four primary causes of pulmonary hemorrhage at PICU. Different causes of pulmonary hemorrhage manifest different characteristics.If the symptom of a patient shows heart rate increase, dyspnea, moist rales and blood oxygen saturation decreased with bleeding tendency and pulmonary infiltration by chest X-ray, he can be suspected of pulmonary hemorrhage.

Pulmonary Hemorrhage Associated With Severe Leptospirosis – The Role Of Low Dose Intravenous Methylprednisolone

@#Leptospirosis has a wide range of presentation which ranges from mild flu-like symptoms, to severe form including renal failure, liver failure, and hemorrhage. Pulmonary involvement can progress from subtle clinical features to life threatening pulmonary hemorrhage and acute respiratory distress syndrome. Although benefits of corticosteroids in adult respiratory distress syndrome have been proven and accepted, evidence for use of corticosteroids in pulmonary leptospirosis is still limited. Given the vasculitic nature of severe leptospirosis, it has been proposed that addition of intravenous corticosteroid therapy, particularly in cases of pulmonary involvement is beneficial. We report a case of leptospirosis with suspected pulmonary hemorrhage which deteriorates after a few days of admission in our tertiary hospital. We have demonstrated that the prescription of a lower dose of corticosteroid than what was widely reported in the literature can equally led to a satisfactory recovery of the pulmonary hemorrhage.

Nursing care of two cases of anti-glomerular basement membrane disease / 现代临床护理

Objective To summarize the experience in nursing 2 patients with anti-glomerular basement membrane disease.Method The nursing measures such as close observation of disease condition,careful nursing of medication,nursing during the treatment of double filtrated plasmapheresis and mental care to the patients and their family members.Results After treatment,the concentration of anti-GBM antibody was declined and the level of serum creatinine was also decreased.The renal function got rccovered to a certain extent.Conclusion Such nursing points as close observation of renal and pulmonary pathgenesis,timely and accurate administration of medicine according to doctor's orders and active observation and prevention of complication from double filtrated plasmapheresis are key.

Diagnosis of pulmonary hemorrhage of the newborn infants using lung ultrasonography / 中华儿科杂志

Objective@#To investigate the accuracy and reliability of lung ultrasound in diagnosis of pulmonary hemorrhage of the newborn infants.@*Method@#From January 2014 to May 2016, 142 neonates from the Army General Hospital of the Chinese PLA were enrolled in the study. They were divided into two groups: a study group of 42 neonates, who were diagnosed with pulmonary hemorrhage according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease. All subjects underwent bedside lung ultrasound in a quiet state in a supine, lateral or prone posture, performed by a single experienced physician. The ultrasound findings were compared between the two groups.Fisher′s exact test was uesd for comparison between two groups.@*Result@#The lung ultrasound main findings associated with pulmonary hemorrhage included: (1) Shred sign: which was seen in 40 patients(95%). (2) Lung consolidation with air bronchograms: which were seen in 35 patients(83%). (3) Pleural effusion: which was seen in 34 infants(81%), pleurocentesis confirmed that the fluid was really bleeding.(4)Atelectasis: which was seen in 14 cases(33%). (5) Pleural line abnormalities and disappearing A-lines with an incidence of 100%. (6) Alveolar-interstitial syndrome: 5 patients(12%)had the main manifestations of alveolar-interstitial syndrome. The above signs were not seen in normal controls (all P<0.01) and the normal lung mainly manifested with clear pleural line and A-lines under ultrasound.@*Conclusion@#Lung ultrasonography is accurate and reliable for diagnosing pulmonary hemorrhage, which is suitable for routine application for the diagnosis of pulmonary hemorrhage in the neonatal intensive care unit.

Risk factors and outcomes for pulmonary hemorrhage in very low birth weight and extremely low birth weight infants / 中国小儿急救医学

Objective To explore the risk factors and outcomes associated with pulmonary hemorrhage in very low and extremely low birth weight infants.Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants (birth weight less than 1200g) admitted to NICU of Shengjing Hospital from Jan.2010 to Dec.2015.Infants at similar birth weight without pulmonary hemorrhage were as controls.We compared the characteristics of both maternal and infants.Multivariable Logistic regression models were derived to predict pulmonary hemorrhage.Short outcomes of the infants were assessed.Results Of the 435 neonates,71 developed pulmonary hemorrhage (pulmonary hemorrhage group),364 were as controls (control group).Gestational age[(28.2±1.7)week],birth weight[(936±192)g] in pulmonary hemorrhage group were significantly lower than those in control group[(29.5±2.1)week,(1033±134)g,t=4.776,5.145,P<0.01].Neonatal respiratory distress syndrome(RDS)(76.1%),pulmonary surfactant (PS)use(PS use≥2 courses)[76.1%(9.9%)],patent ductus arteriosus (PDA)(66.2%)were significantly higher than those in control group[41.2%,30.8%(4.1%),38.7%;χ2=33.457,28.970(4.074),32.798,P<0.05].Antenatal corticosteroids utility ratio (21.1%)was lower than that in the control group (41.2%;t=10.177,P< 0.001).Multiple factors Logistic stepwise regression analysis showed that RDS (OR=3.739,95%CI 1.383-10.113,P<0.05 ),PDA (OR=2.206,95%CI 1.205-4.093,P<0.05),and 5 minutes Apgar score <7(OR=2.851,95%CI 1.191-6.828) were independent risk factors of pulmonary hemorrhage,and higher birth weight (OR=0.998,95%CI 0.996-1.000,P<0.05) and the use of antenatal corticosteroids (OR=0.432,95%CI 0.224-0.834,P<0.05) were the protection factors in pulmonary hemorrhage.In pulmonary hemorrhage group,the incidence of intracranial hemorrhage,retinopathy of prematurity and severe bronchopulmonary dysplasia(16.9%,12.7% and 18.3%) were significantly higher than those in control group (5.8%,4.4% and 2.2%;χ2=36.824,7.520 and 33.568,P<0.01);Compared to control group,the mortality in pulmonary hemorrhage group was higher (49.3% vs.14.0%;χ2=46.634,P<0.01).Conclusion Pulmonary hemorrhage in very low and extremely low birth weight infants is associated with multiple factors.Prevention of premature birth and prenatal corticosteroids treatment can help prevent the occurrence of pulmonary hemorrhage.The incidences of poor outcomes are higher in newborns with pulmonary hemorrhage.

Analysis of the correlative factors of neonatal deaths in neonatology department / 中国新生儿科杂志

Objective To analyze the correlative factors of neonatal deaths in neonatology department to improve the treatment level and reduce the death rate of the hospitalized newborn patients.Method The medical records and death review data of the infants who died in the neonatology department of the Hospital from 2009 to 2015 were retrospectively reviewed.They were assigned to three groups according to the therapeutic measures before their death,including comfort care group,do not resuscitate (DNR) group and active treatment group.Gestational age,birth weight,postnatal age at death and the direct cause of death were compared between groups by x2 test.Result A total of 337 infants were enrolled in this study.There were 112 cases (33.2％) in the comfort care group,73 cases (21.7％) in the DNR group and 152 cases (45.1％) in the active treatment group.Compared to the proportion of the different group during 2009-2012,the proportion of the comfort care group during 2013-2015 significantly increased(38.9％ vs.27.2％,P =0.023),and the proportion of the active treatment group significantly decreased (38.3％ vs.52.5％,P =0.009),while the proportion of the DNR group showed no significant difference (22.9％ vs.20.4％,P =0.580).The proportion of the comfort care group was significantly higher in the group of neonates who died in early neonatal period than that in the late neonatal period and post-neonatal period (42.9％ vs.9.3％,P ＜0.001),while the proportion of the active treatment group and DNR group decreased(17.9％ vs.30.9％,P =0.009;39.2％ vs.59.8％,P =0.001).The proportion the comfort care group increased with the decrcasing gestational age and birth weight (P =0.001 and 0.002).Of the 34 term infants,the top two principle causes of death were severe asphyxia (4.1.1％,14.cases) and congenital defects (32.4％,11 cases).Of the 303 preterm infants,the top three direct causes of death were neonatal respiratory distress syndrome (31.4％,95 cases),neonatal pulmonary hemorrhage (22.4％,68 cases) and congenital defects (6.3％,19 cases).Conclusion The proportion of comfort care and DNR was higher than the proportion of active treatment before the newborns' death and it was relative to gestational age and birth weight.Preterm infants were the predominant population of the infant deaths in the neonatology department.Neonatal respiratory distress syndrome was the principle cause of death in preterm infants,and severe asphyxia was the main cause of death in term infants.

Avaliação endoscópica das vias aéreas, do perfil de gases, dos eletrólitos e do equilíbrio ácido-base em equinos submetidos ao treinamento de três tambores / Endoscopic airway, blood gas, electrolytes, and acid-base in equine submitted to three-barrel training

O objetivo deste estudo foi avaliar as vias aéreas por endoscopia, o perfil de gases, de eletrólitos e o equilíbrio ácido-base de equinos da raça Quarto de Milha (QM) antes e após o exercício de três tambores. Dezesseis cavalos, divididos em dois grupos de oito animais, treino regular (TR - cinco vezes) e treino esporádico (TE - duas vezes por semana), foram utilizados no experimento. A endoscopia foi realizada antes e 90 min após o exercício. Foram realizadas duas coletas de sangue por punção da artéria facial transversa antes do aquecimento (M0) e imediatamente após o exercício (M1), e as leituras foram realizadas com o I-Stat(r). Foram determinadas PCO2, PO2, SO2, pH, BE, HCO3 e TCO2, Na+, K+, iCa, glicose, Hg e Ht. Foi utilizada ANOVA com medidas repetidas no tempo para comparações dos grupos e dos momentos (P<0,05). A HFL acometeu em grau leve (1-2) os animais de ambos os grupos, com 8/8 (100%) no TR e 5/8 (62,5%) no TE. Observou-se presença de secreção serosa na traqueia em 4/8 (50%) para ambos os grupos. A HPIE acometeu em grau leve (1-2) os animais de ambos os grupos, com 4/8 (50%) no grupo TR e 3/8 (37,5%) no grupo TE. Os animais com grau 2 de HPIE apresentaram leve hipoxemia e hipercapnia pós-exercício. SO2, PCO2, pH, HCO3, BE, K e iCa+ não diferiram estatisticamente (P>0,05) entre os grupos. Os cavalos da raça QM submetidos ao exercício de TT apresentam HPIE e acidose metabólica.(AU)

The aim of this study was to evaluate the airways by endoscopy, gas profile, electrolytes and acid-base balance of horses in the Quarter Horse (QM) race before and after training three drums. Sixteen horses divided into two groups of 8 animals, with regular training (RT - 5 times a week) and sporadic training (ET - 2 times a week) were used in the experiment. Endoscopy was performed before and 90 min after training. Two blood samples were taken by puncturing the transverse facial artery before heating (M0) and immediately after training (M1), and the readings were performed with the I-Stat(r). PCO2, PO2, SO2, pH, BE, HCO3 and TCO2, Na +, K +, iCa, Glucose, Hg, and Ht were determined. ANOVA was used with repeated measures over time for comparisons of groups and time (P<0.05). The HFL befell was mild (1-2), the animals from both groups with 8/8 (100%) in the TR and 5/8 (62.5%) for the TE. There was presence of serous trachea 4/8 (50%) for both groups. The EIPH befell was mild (1-2) in the animals from both groups with 4/8 (50%) in the RT group and 3/8 (37.5%) for the TE group. Animals with grade 2 EIPH had mild hypoxemia and hypercapnia after exercise. The SO2, PCO2, pH, HCO3, BE, K, and iCa did not differ P <0.05 between groups. QM race submitted to TT exercise have EIPH and metabolic acidosis.(AU)