Pulmonary hemorrhage in neonates of early and late gestation.
Our objectives in this study of pulmonary hemorrhage (PH) were to define common characteristics of infants who develop PH, identify factors associated with PH and report the outcome. Neonates (42/2980 admissions) with PH and matched controls were identified. Early gestation (< or = 35 weeks) infants with PH [EGPH] (n = 34; 12 survived) had occurrence of PH at 3.6 +/- 1.1 (mean +/- sem) days and were significantly associated with multiple births (p = 0.03), RDS (p < 0.01) and use of Survanta (p < 0.02). Among EGPH, small for gestational age (SGA) infants (n = 7) had a 100% mortality rate. Late gestation (> or = 36 weeks) infants with PH [LGPH] (n = 8; 6 survived) had occurrence of PH at 0.7 +/- 0.3 days and were significantly associated with low 1 minute (p = 0.04) and 5 minutes (p = 0.01) Apgar scores. All infants were managed with increases in mean airway pressure (MAP) and/or use of cocaine/epinephrine through the endotracheal tube. We have identified 2 groups of neonates with distinct factors associated with PH; use of 1:10,000 epinephrine (0.1 ml/kg) and/or 4% cocaine (4 mg/kg) may be useful adjuncts to increases in MAP for management of PH.
Bhandari
V
V
Department of Pediatrics, University of Connecticut Health Center, Farmington, USA. bhandarv@aehn2.einstein.edu
Gagnon
C
C
Rosenkrantz
T
T
Hussain
N
N
D001688:Biological Products; D001724:Birth Weight; D003042:Cocaine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005865:Gestational Age; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011175:Positive-Pressure Respiration; D011663:Pulmonary Surfactants / Q000009:adverse effects / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D001688:Biological Products; D011663:Pulmonary Surfactants; D003042:Cocaine; C072197:beractant; D004837:Epinephrine