Risk factors and outcomes for pulmonary hemorrhage in very low birth weight and extremely low birth weight infants

Abstract

Objective To explore the risk factors and outcomes associated with pulmonary hemorrhage in very low and extremely low birth weight infants. Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants (birth weight less than 1 200 g) admitted to NICU of Shengjing Hospital from Jan.2010 to Dec. 2015.Infants at similar birth weight without pulmonary hemorrhage were as controls.We compared the characteristics of both maternal and infants.Multivariable Logistic regression models were derived to predict pulmonary hemorrhage.Short outcomes of the infants were assessed. Results Of the 435 neonates, 71 developed pulmonary hemorrhage (pulmonary hemorrhage group), 364 were as controls (control group). Gestational age[(28.2±1.7)week], birth weight[(936±192)g] in pulmonary hemorrhage group were significantly lower than those in control group[(29.5±2.1)week, (1 033±134)g, t=4.776, 5.145, P<0.01]. Neonatal respiratory distress syndrome(RDS)(76.1%), pulmonary surfactant (PS)use(PS use≥2 courses)[76.1%(9.9%)], patent ductus arteriosus (PDA)(66.2%)were significantly higher than those in control group[41.2%, 30.8%(4.1%), 38.7%; χ2=33.457, 28.970(4.074), 32.798, P<0.05]. Antenatal corticosteroids utility ratio (21.1%)was lower than that in the control group (41.2%; t=10.177, P< 0.001). Multiple factors Logistic stepwise regression analysis showed that RDS (OR=3.739, 95%CI 1.383-10.113, P<0.05 ), PDA (OR=2.206, 95%CI 1.205-4.093, P<0.05), and 5 minutes Apgar score <7(OR=2.851, 95%CI 1.191-6.828) were independent risk factors of pulmonary hemorrhage, and higher birth weight (OR=0.998, 95%CI 0.996-1.000, P<0.05) and the use of antenatal corticosteroids (OR=0.432, 95%CI 0.224-0.834, P<0.05) were the protection factors in pulmonary hemorrhage.In pulmonary hemorrhage group, the incidence of intracranial hemorrhage, retinopathy of prematurity and severe bronchopulmonary dysplasia(16.9%, 12.7% and 18.3%) were significantly higher than those in control group (5.8%, 4.4% and 2.2%; χ2=36.824, 7.520 and 33.568, P<0.01); Compared to control group, the mortality in pulmonary hemorrhage group was higher (49.3% vs.14.0%; χ2=46.634, P<0.01). Conclusion Pulmonary hemorrhage in very low and extremely low birth weight infants is associated with multiple factors.Prevention of premature birth and prenatal corticosteroids treatment can help prevent the occurrence of pulmonary hemorrhage.The incidences of poor outcomes are higher in newborns with pulmonary hemorrhage. Key words: Neonatal pulmonary hemorrhage; Very low birth weight infants; Extremely low birth weight infants; Risk factors,