Pulmonary hemorrhage in very low-birthweight infants: risk factors and management.
BACKGROUND
Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low-birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH.


METHODS
Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000-2006 and 2007-2010.


RESULTS
Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000-2006; 18.2% survival rate), and five in the second group (2007-2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality.


CONCLUSIONS
Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.
Division of Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. yiyychen@vghks.gov.tw
Ying-Yao
YY
Chen
Hsiao-Ping
HP
Wang
Shu-Ming
SM
Lin
Jenn-Tzong
JT
Chang
Kai-Sheng
KS
Hsieh
Fu-Kuei
FK
Huang
Yee-Hsuan
YH
Chiou
Yung-Feng
YF
Huang
D019468:Disease Management; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006469:Hemoptysis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000628:therapy; D019102:Infant, Very Low Birth Weight; D007322:Instillation, Drug; D007442:Intubation, Intratracheal; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D014132:Trachea; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D011663:Pulmonary Surfactants; D014662:Vasoconstrictor Agents; D004837:Epinephrine