Association between pulmonary hemorrhage and CPAP failure in very preterm infants

Abstract

BackgroundPulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study.MethodsThis was a multicenter case–control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24–32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses.ResultsA total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48).ConclusionsIn this multicenter case–control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana

“…According to the literature ( 13 ), bleeding into the lungs occurs mainly in premature newborns with severe lung disease. Risk factors have been proposed to be respiratory problems ( 14 ) and hemodynamically significantly increased blood flow (persistent ductus arteriosus, PDA) in the blood vessels in the lungs ( 15 ), like when sepsis impacts on hemodynamics and reopens or enlarges the patent ductus arteriosus. In newborns, infection ( 8 ), in accordance with our findings of sepsis and shock being highly associated with PH, as well as the association of PH with apnea of prematurity ( 16 ), is in line with the results of our study.…”

Factors influencing pulmonary hemorrhage in very low-and extremely low-birth-weight infants: a meta-analysis

“…A total of 251 studies were retrieved; after removing duplicates, initial screening and reading the full texts, a total of 13 studies were included [17][18][19][20][21][22][23][24][25][26][27][28][29] . The literature screening process is shown in Figure 1.…”