Pulmonary hemorrhage in preterm neonates: risk factors and management

ABSTRACT

Pulmonary hemorrhage in neonates is an acute catastrophic event requiring prompt recognition and emergency intervention. It represent one end of a spectrum of disorders characterized by pulmonary oedema. It is characterized by sudden onset, rapid progression into respiratory failure and high mortality. Twenty two babies with documented pulmonary hemorrhage were analysed for risk factors. High frequency oscillatory ventilation [HFOV] as a rescue strategy for respiratory support of those patients was assessed by comparing oxygenation before and after its use. Pulmonary hemorrhage was exclusively seen among preterm babies during the period of the study. Al 22 babies suffered a primary respiratory illness namely respiratory distress syndrome [RDS], all [100%], received surfactant. Fourteen babies [70%] had patent ductus arteriosus [PDA]. Out of 22 babies, 7 babies [2%] expired, 15 babies [68%] survived. Oxygenation improved after HFOV. In survivors, oxygen index [OI] before HFOV was 14.2 +/- 1.1, compared to 14.9 +/- 1.2 in non survivors. While, after HFOV, OI was 6.7 +/- 0.7 in survivors, compared to 12.8 +/- 1.2 in non survivors. P-value<0.05. A similar trend was seen for a/ApO[2]. Pulmonary hemorrhage is a life threatening condition, with high mortality rate. Mortality is more common in extremely low birth weight infants [ELBW], who had RDS, received surfactant therapy and had significant PDA.HFOV is a good option to ventilate those babies who suffered this serious complication