Neonatal Death and Massive Pulmonary Haemorrhage in Jamaica

Abstract

Massive pulmonary haemorrhage in the newborn is a well-recognized but little understood condition, characterized by the presence in the alveoli and alveolar ducts, and sometimes in the interstitial spaces, of large numbers of erythrocytes. The distribution of haemorrhage may be patchy or confluent causing consolidation, as distinct from the petechial haemorrhages seen in infants dying after premature separation of the placenta, or the septal haemorrhages seen in stillbirths. The condition was probably first described by Browne (1922a) Indies, of which 336 were neonatal deaths and 231 were stillbirths. In this period there were 14,013 births in the obstetric unit and domiciliary service, of which 304 were stillborn and 301 died in the neonatal period. The additional autopsies on newborns were performed on infants from other hospitals in Kingston. The population served by the hospital is multiracial: there is some selection, as the majority of patients come from the poorer classes. The racial constitution of the autopsy population (Bras, Brooks and Watler, 1961) is Negro or mixed-97-2%, White-1-2%, Chinese-08% and East Indian-0 8%.Method of Examination. The autopsy records of all the perinatal deaths were examined and all cases mentioning the presence of pulmonary haemorrhage of any type were scrutinized. The clinical records, gross autopsy findings and microscopic sections were examined. Lung sections were available from all autopsies. Blocks of lung tissue had been fixed in 10% neutral buffered formalin and embedded in paraffin wax. Sections were stained with haematoxylin and eosin.Conditions of Study. Criteria for selection were as follows:1. Death occurred in the first or second week of life; stillbirths were excluded.

Certain Causes of Neonatal Death. IV. Massive Pulmonary Haemorrhage

“…Although twins have been excluded from the present anal yses, it is interesting to note that, in the Perinatal Mortality Survey the incidence of MPH was at least 7 times as high among twins as singletons [Butler and Alberman, 1969]. Other authors have also found a high proportion of twins in their series of cases with MPH [Ahvenainen, 1956;T horburn, 1963;Rowe and Avery, 1966].…”

“…The majority of authors have frequencies of between 7 and 10% [Briggs and H ogg, 1958;Ahvenainen, 1956;Sant and Purandare, 1962;T horburn, 1963].…”

“…As recently as 1957, P olleri et al reasoned that the condition was the result of an infection, but only rarely has an infective agent been isolated from the lungs, nor is any inflammatory exudate normally present [Claireaux, 1963]. It has also been suggested that the lesion is caused by an inha lation of gastric juices [Rhaney and MacG regor, 1948;T horburn, 1963], and oxygen therapy [Shanklin and Wolfson, 1967] but the evidence for the latter is not conclusive [Avery and deLemos, 1968].…”

Clinical Research Informing Neonatal Care at the University Hospital of the West Indies: 50 Years Experience

“…Pulmonary haemorrhage occurred in 8% of neonatal deaths; 52% of cases died early in the neonatal period. Anoxia was considered to be the main causal agent in the majority of early cases (4).…”