Pulmonary hemorrhage in extremely low birth weight infants: Significance of the size of left to right shunting through a valve incompetent patent foramen ovale

Pulmonary hemorrhage in preterm infants born <29 weeks' gestation: a population cohort study

OBJECTIVE

To evaluate the incidence, clinical characteristics and outcomes of pulmonary hemorrhage (PH) in preterm infants who were born <29 weeks' gestation in relation to their small for gestational age (SGA) status.

STUDY DESIGN

This retrospective cohort study included preterm infants born <29 weeks' gestation and admitted to one of eight tertiary perinatal hospitals in New South Wales and The Australian Capital Territory, Australia from 1 January 2007 to 31 December 2019. Data for analysis was obtained from the Neonatal Intensive Care Units' (NICUs) database. Temporal trends and changes in the outcomes were examined using multivariable logistic regression models.

RESULTS

The median gestational age was 27 weeks' (interquartile range (IR): 25-28) and the median birth weight was 928 g (IR: 756-1,106). PH occurred in 281/4,823 infants (5.8 %). PH more than doubled in SGA compared to appropriately grown infants (11.1 %: 39/353 versus 5.4 %: 242/4,470, difference 5.7; 95 % CI:2.14-9.12) and in infants born <26 weeks compared to ≥26 weeks (137/1,356: 10.1 % versus 144/3,467: 4.2 %, difference 5.9; 95 % CI:4.16-7.63). After confounder adjustments, PH was associated with a higher predischarge mortality (OR:3.97, 95 % CI:3.00-5.24) and severe intraventricular hemorrhage (OR:4.2, 95 % CI:3.10-5.67) but made no difference in levels of functional impairment at 2-3 years corrected age (OR:1.13, 95 % CI:0.77-1.66).

CONCLUSION

PH was more common in infants born SGA and in those born <26 weeks' gestation. PH was associated with poorer predischarge clinical outcomes. Timely risk prediction is needed to improve outcomes in these infants.

Prophylactic indomethacin and the risk of serious pulmonary hemorrhages in preterm infants less than 28 weeks' gestation

OBJECTIVE

To determine if prophylactic indomethacin (PINDO) decreases serious pulmonary hemorrhages in infants <28 weeks.

STUDY DESIGN

Intention-to-treat analysis of 615 consecutively admitted infants during four alternating protocol-driven epochs of PINDO or expectant patent ductus arteriosus (PDA) management.

RESULTS

41/615 (6.7%) developed serious pulmonary hemorrhage at 2 (1, 3) days (median (IQR)). In unadjusted and adjusted multivariable models, infants born in a PINDO epoch had significantly lower incidences of pulmonary hemorrhage and pulmonary hemorrhage or death before 7 days. There were less moderate/large PDA during PINDO epochs. The associations between PINDO and pulmonary hemorrhage and pulmonary hemorrhage/death were no longer significant when presence of a PDA was included in the analyses. There was no apparent association between PINDO epochs and the incidence of serious intraventricular hemorrhages.

CONCLUSION

Even though PINDO no longer appears to affect the incidence of sIVH it still is associated with a lower incidence of pulmonary hemorrhage.

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

Introduction

Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting.

Methods and materials

A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X² and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage.

Result

There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage.

Conclusion

This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.