Prognostic Factors in Premature Infants with Pulmonary Hemorrhage occuring after Surfactant Replacement

ABSTRACT

PURPOSE: Exogenous surfactant replacement therapy reduces morbidity and mortality rates for premature babies with respiratory distress syndrome (RDS). A significant increase in clinical pulmonary hemorrhage has been reported in premature babies treated with surfactant. Pulmonary hemorrhage, one of the major cause of death, may develop due to an increased pulmonary blood flow. We investigated the prognostic factors for mortality in premature infants with pulmonary hemorrhage after surfactant replacement, and to predict the survival of infants having RDS. METHODS: We investigated the characteristics and clinical courses of the 22 premature infants who developed pulmonary hemorrhage after surfactant therapy for RDS hospitalized at Seoul Red Cross Hospital between Dec 1994 and May 1998. We divided the patients into two groups ' Group I were those who survived (n=6) and Group II were those who expired after pulmonary hemorrhage (n=16). RESULTS: There were no differences in birth weight, gestational age and radiologic staging between two groups (P>0.05). Low Apgar score at birth was significantly related to mortality in premature infants with pulmonary hemorrhage (P<0.05). The interval between birth and onset of pulmonary hemorrhage and the interval between the surfactant replacement and onset of pulmonary hemorrhage were significantly longer in Group I than in Group II (P<0.05). CONCLUSION: The clinical conditions at birth, the interval between birth and onset of pulmonary hemorrhage, and the interval between surfactant replacement and onset of pulmonary hemorrhage were the prognostic factors of mortality in preterm infants with pulmonary hemorrhage.