Pulmonary Hemorrhage (PH) in Extremely Low Birth Weight (ELBW) Infants: Successful Treatment with Surfactant

Suryawanshi, Pradeep

doi:10.7860/jcdr/2015/8596.5691

Cited by 5 publications

(13 citation statements)

References 9 publications

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“…Massive pulmonary hemorrhage is a life-threatening condition that, according to current literature, complicates hospital course in 3%-5% of preterm infants and generally occurs in 1-12 per 1000 live births, with the rate increasing to 50 per 1000 live births in the groups at risk such as prematurity and severe illnesses [1][2][3] . In our region, we found the incidence of MPH to be 1.91% of total premature births, 4.35% of NICU treated preterm neonates, and 7.44% of those requiring mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…In studies from the 1990s, MPH occurred in both preterm and full-term neonates, however, in preterm infants it developed later and was associated with a higher mortality rate than in full-term infants 11,12 . Recent major studies have just highlighted lower gestational age and lower birth weight as the strongest risk factors for the development of MPH 2,3 .…”

Section: Discussionmentioning

confidence: 99%

“…Older papers have reported MPH in both preterm and full-term neonates, with a higher mortality rate in preterm infants, and usually related to perinatal asphyxia, surfactant deficiency, and some serious illnesses 1 . Currently, it is more often described in preterm ventilated neonates, with different incidence reports [1][2][3] . Typical presentation is dramatic and rapid deterioration that starts with reddish foamy discharge in the endotracheal tube or mouth.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcome of Massive Pulmonary Hemorrhage in Preterm Infants in Tuzla Canton

Hadžić

Zulić

Salkanović-Delibegović

et al. 2021

ACC

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Massive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcome of Massive Pulmonary Hemorrhage in Preterm Infants in Tuzla Canton

Hadžić

Zulić

Salkanović-Delibegović

et al. 2021

ACC

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“…In our cohort, the rate of PH in ELBWIs was 18.8%. It has been shown that SGA, EOS, low birth weight (LBW), lower Apgar scores at 1 and 5 minutes, severe RDS and surfactant replacement are risk factors for PH [12]. Usually, smaller gestational age and lower birth weight increase the odds of EOS in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants

et al. 2019

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Background Pulmonary hemorrhage (PH) is a life-threatening respiratory complication of extremely low-birth-weight infants (ELBWIs). However, the risk factors for PH are controversial. Therefore, the purpose of this study was to analyze the perinatal risk factors and short-term outcomes of PH in ELBWIs. Methods This was a retrospective cohort study of live born infants who had birth weights that were less than 1000 g, lived for at least 12 hours, and did not have major congenital anomalies. A logistic regression model was established to analyze the risk factors associated with PH. Results There were 168 ELBWIs born during this period. A total of 160 infants were included, and 30 infants were diagnosed with PH. Risk factors including gestational age, small for gestational age, intubation in the delivery room, surfactant in the delivery room, repeated use of surfactant, higher FiO 2 during the first day, invasive ventilation during the first day and early onset sepsis (EOS) were associated with the occurrence of PH by univariate analysis. In the logistic regression model, EOS was found to be an independent risk factor for PH. The mortality and intraventricular hemorrhage rate of the group of ELBWIs with PH were significantly higher than those of the group of ELBWIs without PH. The rates of periventricular leukomalacia, moderate-to-severe bronchopulmonary dysplasia and severe retinopathy of prematurity, and the duration of the hospital stay were not significantly different between the PH and no-PH groups. Conclusions Although PH did not extend hospital stay or increase the risk of bronchopulmonary dysplasia, it increased the mortality and intraventricular hemorrhage rate in ELBWIs. EOS was the independent risk factor for PH in ELBWIs.

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“…Pulmonary hemorrhage (PH) occurs in 3–5% of mechanically ventilated pre-term infants and in up to 8.6% of those born extremely premature (23–24 weeks' gestation) ( 5 , 6 ). Additional risk factors include small for gestational age status, low Apgar scores, sepsis, presence of a patent ductus arteriosus (PDA), and severe respiratory distress syndrome ( 7 ). It most commonly occurs in the first 2 days of life and is associated with an increase in mortality overall and at 7 days of life ( 5 ).…”

Section: Clinical Overview Of Bleeding In the Neonatementioning

confidence: 99%

Hemostatic Challenges in Neonates

Davenport

Sola‐Visner

2021

Front. Pediatr.

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The neonatal hemostatic system is strikingly different from that of adults. Among other differences, neonates exhibit hyporeactive platelets and decreased levels of coagulation factors, the latter translating into prolonged clotting times (PT and PTT). Since pre-term neonates have a high incidence of bleeding, particularly intraventricular hemorrhages, neonatologists frequently administer blood products (i.e., platelets and FFP) to non-bleeding neonates with low platelet counts or prolonged clotting times in an attempt to overcome these “deficiencies” and reduce bleeding risk. However, it has become increasingly clear that both the platelet hyporeactivity as well as the decreased coagulation factor levels are effectively counteracted by other factors in neonatal blood that promote hemostasis (i.e., high levels of vWF, high hematocrit and MCV, reduced levels of natural anticoagulants), resulting in a well-balanced neonatal hemostatic system, perhaps slightly tilted toward a prothrombotic phenotype. While life-saving in the presence of active major bleeding, the administration of platelets and/or FFP to non-bleeding neonates based on laboratory tests has not only failed to decrease bleeding, but has been associated with increased neonatal morbidity and mortality in the case of platelets. In this review, we will present a clinical overview of bleeding in neonates (incidence, sites, risk factors), followed by a description of the key developmental differences between neonates and adults in primary and secondary hemostasis. Next, we will review the clinical tests available for the evaluation of bleeding neonates and their limitations in the context of the developmentally unique neonatal hemostatic system, and will discuss current and emerging approaches to more accurately predict, evaluate and treat bleeding in neonates.

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Pulmonary Hemorrhage (PH) in Extremely Low Birth Weight (ELBW) Infants: Successful Treatment with Surfactant

Cited by 5 publications

References 9 publications

Short-Term Outcome of Massive Pulmonary Hemorrhage in Preterm Infants in Tuzla Canton

Short-Term Outcome of Massive Pulmonary Hemorrhage in Preterm Infants in Tuzla Canton

Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants

Hemostatic Challenges in Neonates

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