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Barnes ME, Feeney E, Duncan A, Jassim S, MacNamara H, O’Hara J, Refila B, Allen J, McCollum D, Meehan J, Mullaly R, O’Cathain N, Roche E, Molloy EJ. Pulmonary haemorrhage in neonates: Systematic review of management. Acta Paediatr 2022; 111:236-244. [PMID: 34582587 DOI: 10.1111/apa.16127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
AIM Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. METHODS A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes. RESULTS Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline. Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability. Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. CONCLUSION There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.
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Affiliation(s)
- Melissa E. Barnes
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Emily Feeney
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Andrew Duncan
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Samher Jassim
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Honora MacNamara
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Joseph O’Hara
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Beshoy Refila
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - John Allen
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Danielle McCollum
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Judith Meehan
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Rachel Mullaly
- Coombe Women and Infants University Hospital Dublin Ireland
| | - Niamh O’Cathain
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
| | - Edna Roche
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Eleanor J. Molloy
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
- Trinity Biomedical Sciences Institute (TTMI)TCD Dublin Ireland
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Welde MA, Sanford CB, Mangum M, Paschal C, Jnah AJ. Pulmonary Hemorrhage in the Neonate. Neonatal Netw 2021; 40:295-304. [PMID: 34518381 DOI: 10.1891/11-t-696] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Pulmonary hemorrhage (PH) is a pathology associated with significant morbidity and mortality, particularly among preterm infants in the NICU. The diagnosis is made when hemorrhagic secretions are aspirated from the trachea concurrent with respiratory decompensation that necessitates intubation or escalated support. The implementation of mechanical ventilation and widespread exogenous surfactant administration have significantly reduced respiratory morbidities. However, when PH develops, death remains the most common outcome. Treatment for PH remains primarily supportive; thus, a thorough understanding of underlying disease processes, manifestations, diagnostic testing, and current evidence is vital to enable early identification and proactive management to reduce morbidity and mortality.
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Abstract
Perinatal pulmonary hemorrhage (PH) is a condition characterized by blood loss via the respiratory tract with an approximate incidence of 0.1% in all newborns. The histologic characteristics of the lung in PH are not well characterized, and we hypothesized that pulmonary maldevelopment such as pulmonary hypoplasia may contribute to PH. In addition, we sought to find any correlations with placental pathology. Retrospective study of fetal and neonatal autopsies with diagnosis of PH was performed between the years from 2009 to 2015. Autopsy reports, placental pathology reports, and hematoxylin and eosin sections of the lung were reviewed. Of the 17 cases which were identified meeting inclusion criteria, PH ranged from mild (<5% in each lung) to severe (>75% in both lungs). PH involved >50% of both lungs in 6 cases. Pulmonary hypoplasia was designated in 7 of 17 (41.17%) cases with PH. Pulmonary hypoplasia and/or persistence of intra-acinar arterioles was seen in 13 of 17 (76.4%) cases. No specific placental pathology was seen universally in the cases of PH, but either maternal or fetal vascular malperfusion was noted in 14 of 17 (82%) cases. Our data suggest a high prevalence of pulmonary maldevelopment, such as pulmonary hypoplasia and persistence of intra-acinar arterioles, in cases with PH. Although no specific placental pathology is seen in PH, maternal and fetal vascular pathology is common.
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Affiliation(s)
- Indu Agarwal
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, Pissarra S, Costa S, Soares H, Flôr-de-Lima F, Guimarães H. Respiratory Care for the Ventilated Neonate. Can Respir J 2018; 2018:7472964. [PMID: 30186538 PMCID: PMC6110042 DOI: 10.1155/2018/7472964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Américo Gonçalves
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Silva
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Diana Almeida
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Sara Figueiredo
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Susana Pissarra
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Flôr-de-Lima
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Park HJ, Choi EJ. Use of Recombinant Activated Factor VII for Pulmonary Hemorrhage in Premature Infants: A Single-Center Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Jin Park
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Jin Choi
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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Sharma D, Farahbakhsh N, Shastri S, Sharma P. Intrauterine growth restriction - part 2. J Matern Fetal Neonatal Med 2016; 29:4037-48. [PMID: 26979578 DOI: 10.3109/14767058.2016.1154525] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Small for gestational age (SGA) infants have been classically defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age, whereas intrauterine growth restriction (IUGR) has been defined as a rate of foetal growth that is less than normal for the population and for the growth potential of a specific infant. SGA infants have more frequent problems such as perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemia and many more when compared with their appropriate for gestational age counterpart. They too have growth retardation and various major and subtle neurodevelopmental handicaps, with higher rates of perinatal and neonatal mortality. With the advent of newer technologies, even though the perinatal diagnosis of these SGA/IUGR foetuses has increased, but still perinatal morbidity and mortality rates are higher than normal foetuses and infants. In this part, we have covered neonatal IUGR classification, postnatal diagnosis, short-term and long-term complications faced by these IUGR infants.
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Affiliation(s)
- Deepak Sharma
- a Department of Pediatrics , Pt B.D. Sharma, Post Graduate Institute of Medical and Sciences , Rohtak , Haryana , India
| | | | - Sweta Shastri
- c Department of Pathology , N.K.P Salve Medical College , Nagpur , Maharashtra , India , and
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Yum SK, Moon CJ, Youn YA, Lee HS, Kim SY, Sung IK. Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre. J Matern Fetal Neonatal Med 2015; 29:338-43. [PMID: 25567562 DOI: 10.3109/14767058.2014.1000853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival. METHODS Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group. RESULTS Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/7 ± 3.610 versus 29 and 3/7 ± 3.530 weeks, p = 0.009) and lower one-minute (2.342 ± 1.493 versus 4.035 ± 2.079, p < 0.001) and five-minute Apgar scores (2.342 ± 1.493 versus 4.035 ± 2.079, p < 0.001) and required aggressive resuscitation (p = 0.003) and a greater number of inotropes (2.195 ± 1.346 versus 1.069 ± 0.704, p < 0.001). Deceased infants were administered increased amounts of fluid during the first 24 h after birth (117.783 ± 32.325 versus 99.379 ± 17.728 mL/kg, p = 0.004). A relatively short prothrombin time impacted survival (p = 0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p = 0.01). CONCLUSION Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.
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Affiliation(s)
- Sook Kyung Yum
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Cheong-Jun Moon
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Young-Ah Youn
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Hyun Seung Lee
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - So-Young Kim
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - In Kyung Sung
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Kim SY, Park JY, Lee JA, Choi CW, Kim EK, Kim HS, Kim BI, Choi JH. Risk Factor for Massive Pulmonary Hemorrhage Occurring during the First Five Days after Birth in Extremely Low Birth Weight Infants. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sae Yun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Youn Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin A Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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