Massive Pulmonary Hemorrhage Research Articles

Massive Pulmonary Hemorrhage As A Complication of Intrapleural Streptokinase Therapy

Massive Pulmonary Hemorrhage As A Complication of Intrapleural Streptokinase Therapy

Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two Time Periods.

To investigate the impact of proactive perinatal care on periviable preterm infants before and after its implementation. This retrospective cohort study was conducted over a period of 10 y, from 2013 to 2019, referred to as Phase I, and from 2020 to 2022, referred to as Phase II. A total of 162 eligible infants born between 220/7 and 256/7 wk of gestation were included in this analysis. A total of 125 infants were born in phase I, and 37 infants in phase II received proactive care with minimal handling. The mortality decreased from 54.4% to 24.3% (P = 0.001). The composite outcomes of severe brain injury or death, sepsis or death and necrotizing enterocolitis or death were also improved with proactive care. Gestational age [adjusted odds ratio (aOR) 0.900; 95% confidence interval (CI), 0.836-0.970], air leak syndrome (aOR 4.958; 95% CI, 1.681-14.624), massive pulmonary hemorrhage (aOR 4.944; 95% CI, 2.055-11.893), and birth in phase II (aOR 0.324; 95% CI, 0.115-0.912) were independently associated with mortality. The implementation of proactive care with minimal handling resulted in an increased survival rate and a reduction in the combined morbidities between the two time periods. The provision of proactive perinatal care with minimal handling is crucial for improving both the survival rates and clinical outcomes of these vulnerable infants.

Treatment of Post-Tonsillectomy Hemorrhage With Nebulized Tranexamic Acid: Initial Investigation of a Novel Therapeutic Modality.

The use of nebulized tranexamic acid (TXA) in massive pulmonary hemorrhage is well-described. Published utilization in post-tonsillectomy bleeding (PTB) is limited to a single case. This study examines whether TXA resulted in change of operative intervention necessity and narcotic utilization. This was a retrospective cohort study at a single, urban academic medical center in the United States. Chart review was conducted of all patients who presented to the hospital for post-tonsillectomy bleed (PTB) between 3/1/2018 and 7/1/2020. Demographic data, intervention modality, need for control under general anesthesia, and opioid use were collected and analyzed. Twenty-one patients underwent a total of 23 visits for PTB over the study period. Control of hemorrhage without need for operating room intervention for PTB was 100% (6/6) for patients receiving TXA nebulizer and 53% (9/17) for those receiving other treatment modalities. Opioid usage in hospital and on discharge was also lower in patients receiving TXA nebulizers. All results were statistically significant. Our study supports nebulized TXA as an effective, non-invasive mode of hemostasis in patients presenting to the emergency department for post-tonsillectomy hemorrhage. Nebulized TXA may prevent the need for general anesthesia and operative intervention. Otolaryngologists should consider addition of this novel treatment appropriation of TXA to their management options for postoperative tonsillar hemorrhage.

Bronchial Lavage in the Treatment of Severe Bronchopulmonary Pathology in Adults. Approaches to Classification

Introduction Currently, bronchial lavage (BL) is widely used in clinical practice for the treatment of severe bronchopulmonary lesion in adults. However, indications and contraindications for this procedure are not fully defined. In addition, it was not possible to find in the literature a classification of either BL in general or used for therapeutic purposes in particular, which significantly complicates the standardization of procedures for its use in various diseases.Aim of study To determine possible classification characteristics, as well as indications, contraindications for therapeutic BL in adults and possible complications that may arise, based on the analysis of literature data.Results Therapeutic BL can be carried out both as planned and for health reasons. Indications for planned BL are purulent bronchitis, pneumonia, purulentdestructive infiltration, as well as chronic lung diseases: bronchiectasis, interstitial lesions. In turn, the indication for emergency therapeutic BL is progressive acute or chronic respiratory failure, developing due to bronchial obstruction. Such conditions may include massive pulmonary hemorrhage, acute obstruction of the bronchi with mucus and pus, postoperative atelectasis and hypoventilation of the lungs, aspiration of gastric contents, severe bronchial asthma, purulent destruction of the lungs, acute respiratory distress syndrome, thermochemical lesions of the respiratory tract. Contraindications to therapeutic BL can be both absolute and relative. Absolute contraindications are intolerance to drugs used for local anesthesia; decompensated heart and (or) pulmonary failure; acute cerebrovascular accident; various types of arrhythmias; stenosis of the larynx and (or) trachea II–III degree; neuropsychiatric diseases; pain syndrome in the abdominal cavity; extremely serious condition of the patient, when clarification of the diagnosis can no longer affect treatment tactics. Relative contraindications include acute respiratory disease of the upper respiratory tract; coronary artery disease; severe diabetes mellitus; pregnancy (second half); chronic alcoholism; grade III enlargement of the thyroid gland. It should be noted that most of the absolute contraindications are conditional and are not taken into account when performing BL according to vital indications with appropriate medical and technical support. Classification of BL used for medicinal purposes can be carried out according to the following criteria: method of sanitation; access used; level of sanitation; sanitized area; volume and composition of the lavage solution. It is noteworthy that the methods of carrying out procedures for various conditions and diseases still remain unregulated. An exception is the final stage of the therapeutic BL procedure in the case of the use of surfactant preparations, which standardization is regulated by approved standard operating procedures. It should also be noted that bronchial lavage for therapeutic purposes is justified from a pathoanatomical and pathophysiological point of view, but is accompanied by serious, albeit temporary, changes in the lungs, which can be partially avoided by improving the lavage technique.Conclusion All of the above indicates that in order to solve existing problems, it is necessary to conduct systematic research in this direction with the involvement of all interested specialists.

Successful Use of Anticoagulation-free Prolonged Extracorporeal Membrane Oxygenation for Massive Pulmonary Hemorrhage in a Child with Heart Transplant and Mechanical Mitral Valve: A Case Report with Review of Literature

Background: Pulmonary hemorrhage is a rare cause of morbidity and mortality in children. Extracorporeal membrane oxygenation (ECMO) can be used as a rescue mode of support in children with life-threatening respiratory failure. However, the dilemma arises as to how to balance anticoagulation to prevent circuit thrombosis while avoiding bleeding complications or worsening hemorrhage. Clinical Description: We present an adolescent with a history of Noonan syndrome, orthotopic heart transplant, and mechanic mitral valve that required emergent veno-venous (VV) ECMO support due to life-threatening hypoxia related to severe pulmonary hemorrhage secondary to anticoagulation for his prosthetic mitral valve. Management and Outcome: The patient remained on ECMO for 28 days with no anticoagulation and did not receive any anticoagulant or antiplatelet agents postdecannulation for 4 months despite the presence of a mechanical valve. No thrombotic complications to the mechanical valve or the ECMO circuit occurred. Conclusion: Prolonged anticoagulation-free VV-ECMO support may be used as a rescue strategy in patients with massive pulmonary hemorrhage resulting in refractory respiratory failure.

Staged Norwood operation for patients with hypoplastic left heart syndrome and cor triatriatum: a report of two cases

Two patients with hypoplastic left heart syndrome (HLHS) concomitant with cor triatriatum underwent the staged Norwood procedure following hybrid palliation. Cor triatriatum was diagnosed after birth in both cases. Case 1 with aortic stenosis and mitral atresia underwent bilateral pulmonary artery banding at 2 days of age. Subsequently, balloon atrial septostomy was conducted at 21 days of age due to hypoxia and increased intra-atrial pressure gradient. At 2 months of age, concomitant Norwood operation, cor triatriatum repair, and tricuspid valve repair were successfully performed. She has suffered from branch pulmonary artery hypoplasia since then; thus, Fontan operation was out of indication. Case 2 with aortic stenosis and mitral stenosis underwent bilateral pulmonary artery banding at 6 days of age. After that, the patient’s hemodynamic condition remained stable. The Norwood operation concomitant with cor triatriatum repair was performed at 2 months of age. However, during the procedure, massive pulmonary edema and hemorrhage occurred right after the initiation of cardiopulmonary bypass. She could not be weaned from cardiopulmonary bypass.

Double aortic arch and aortotracheal fistula as cause of fatal massive bleeding: a rare and dangerous association

To present a clinical case with an unusual association of DAA with ATF and to reinforce the importance of maintaining high diagnostic suspicion in patients with massive aerodigestive bleeding without an obvious source. A 32-week preterm newborn who required prolonged mechanical ventilation and presented intermittent episodes of massive oropharyngeal bleeding with hemodynamic compromise associated with lower airway obstruction without pulmonary hemorrhage. The patient underwent upper endoscopy and exploratory laparotomy without evidence of bleeding. Flexible nasopharyngolaryngoscopy and direct laryngoscopy also showed no abnormalities. A CT angiography showed complete DAA with indentation of the left dominant arch over the trachea, without severe stenosis or evidence of a fistula. AEF was suspected, so exploratory surgery was considered. However, the patient died before surgery due to a massive pulmonary hemorrhage. The autopsy revealed the presence of ATF. In patients with massive aerodigestive bleeding without an obvious source, the presence of DAA and possible AEF/ ATF should be considered. Imaging studies have a poor performance for this diagnosis, so surgery should be considered for diagnosis and treatment in these patients.

Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19.

Not much is known about the results of nonelective anatomical lung resections in coronavirus disease 2019 (COVID-19) patients put on extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyze the outcome of lobectomy under ECMO support in patients with acute respiratory failure due to severe COVID-19. All COVID-19 patients undergoing anatomical lung resection with ECMO support at a German university hospital were included into a prospective database. Study period was April 1, 2020, to April 30, 2021 (first, second, and third waves in Germany). A total of nine patients (median age 61 years, interquartile range 10 years) were included. There was virtually no preexisting comorbidity (median Charlson score of comorbidity 0.2). The mean interval between first positive COVID-19 test and surgery was 21.9 days. Clinical symptoms at the time of surgery were sepsis (nine of nine), respiratory failure (nine of nine), acute renal failure (five of nine), pleural empyema (five of nine), lung artery embolism (four of nine), and pneumothorax (two of nine). Mean intensive care unit (ICU) and ECMO days before surgery were 15.4 and 6, respectively. Indications for surgery were bacterial superinfection with lung abscess formation and progressive septic shock (seven of nine) and abscess formation with massive pulmonary hemorrhage into the abscess cavity (two of nine). All patients were under venovenous ECMO with femoral-jugular configuration. Operative procedures were lobectomy (eight) and pneumonectomy (one). Weaning from ECMO was successful in four of nine. In-hospital mortality was five of nine. Mean total ECMO days were 10.3 ± 6.2 and mean total ICU days were 27.7 ± 9.9. Mean length of stay was 28.7 ± 8.8 days. Emergency surgery under ECMO support seems to open up a perspective for surgical source control in COVID-19 patients with bacterial superinfection and localized pulmonary abscess.

Minimally invasive methods of treatment of pulmonary bleeding


 
 
 pulmonary bleeding is a life-threatening complication of many diseases, pathological con- ditions and respiratory injuries. In connection with the urgency of the problem of the occurrence of pul- monary bleeding, in recent years, new highly effective methods of diagnosis and treatment of this com- plication have been increasingly used in clinical practice. The main principles of treatment of pulmonary bleeding are prevention of asphyxia and immediate stopping of bleeding. The range of treatment tactics is quite wide: from conservative treatment, temporary cessation of pulmonary bleeding for a period suf- ficient to remove patients from a serious condition, diagnosis of the underlying disease and preparation
 
 
 
 for radical surgery, to emergency elimination of this complication. To date, there is no consensus on a single universal method of diagnosis and treatment of pulmonary hemorrhage, therefore, in order to improve the effectiveness of diagnosis and further treatment of this complication, a systematic approach is recommended, which involves combining several methods. Endoscopic methods cannot in all cases accurately determine the source of bleeding, so they are recommended to be combined with radiological studies, CT, angiography of bronchial arteries. With massive pulmonary bleeding, more importance is attached to surgical intervention, which includes endovascular catheter embolization of bronchial ar-teries. X-ray endovascular occlusion is a minimally invasive and highly effective method of stopping all types of bleeding from the bronchial artery pool, which can be used even in extremely critical patients. Minimally invasive methods: endoscopic and endovascular are leading in the diagnosis and treatment of respiratory diseases complicated by pulmonary bleeding. They allow not only to establish the very fact of pulmonary bleeding and its likely source, but also to implement the entire set of measures aimed at stopping bleeding. Despite the reliability and demand of minimally invasive methods, the question of using one or another method to stop pulmonary bleeding remains unclear, which requires further study of their effectiveness, reliability, and economic validity.
 
 
 
 
 

IMAGING IN MASSIVE PULMONARY HAEMORRHAGE: A RARE COMPLICATION AFTER SEVERE TRAUMA.

Trauma is one of the most common causes of mortality and morbidity in young adults worldwide. A blunt force to the chest causes pulmonary contusion (PC), which is dened as destruction of lung parenchyma. Massive pulmonary haemorrhage (MPH) is caused by pulmonary vascular injury after severe trauma. It is a rare form of pulmonary contusion that is associated with signicant mortality if not recognised early and treated promptly. Here is a case series on the imaging appearance of MPH.

145: SUCCESSFUL MANAGEMENT OF LEFT VENTRICULAR ASSIST DEVICE OFF ANTICOAGULATION FOR 30 DAYS

Introduction: Ventricular assist devices (VAD) have revolutionized the management of heart failure. However, risk of thromboembolic events is a concern. This is addressed by anticoagulation protocol to keep international normalized ratio between 2-3. We present a case of left and right ventricular assist devices (LVAD and RVAD) recipient successfully managed off anticoagulation for 30 days without thromboembolic events. Description: 72-year-old male presented with worsening shortness of breath for a month. Past medical history is significant for non-ischemic cardiomyopathy, Stage-D, NYHA-FC-4, Intermacs-2. Patient was admitted with acute decompensated heart failure. Echocardiogram showed left ventricular ejection fraction of 15% and right systolic ventricular pressure of 80 mmHg. Despite maximum medical management, patient decompensated requiring impella support bridge to LVAD, Heartmate-III and RVAD, Protek duo. Patient was started on heparin and bridged to warfarin and aspirin per anticoagulation protocol with goal INR of 2- 3. Post-op course was complicated by massive pulmonary hemorrhage requiring placement of bronchial blocker and a large episode of melena in the first two weeks, prompting us to hold warfarin and aspirin. Thereafter, patient was managed off anticoagulation to prevent further bleeding episodes. Coagulation profile was negative. RVAD was removed on day-27 and anticoagulation was resumed on day-30. During this time patient did not experience any thromboembolic events despite no anticoagulation. Patient was weaned off ventilatory support, transitioned out of intensive care unit, and subsequently discharged home on LVAD. Discussion: Since the introduction of centrifugal non-pulsatile LVADs, incidence of thromboembolic events, including pump thrombosis, has decreased but at expense of increased gastrointestinal bleeds. This shift brings up need to revise current anticoagulation strategies. In our case, management off anticoagulation prevented further bleeding episodes without any thromboembolic events. Although thrombosis prevention is important while on VAD, clinicians can find comfort in knowing that anticoagulation may be safely withheld when bleeding complications arise. Of point, focus must be maintained on VAD flows to help reduce stagnant blood.

Local pulmonary administration of factor VIIa (rFVIIa) in massive pulmonary haemorrhage in post-operative cardiac infant.

Diffuse pulmonary haemorrhage is an ominous condition that has a high paediatric mortality rate. Recombinant activated factor VIIa (rFVIIa) is a powerful haemostatic agent which has been used intravenously in life-threatening haemorrhage in variety of conditions in which conventional medical or surgical therapy are unsuccessful. We report off-label successful use of endotracheal rFVIIa for massive life-threatening respiratory haemorrhage following aspiration and cardiopulmonary resuscitation in a 3-month-old infant who was anticoagulated with enoxaparin following corrective cardiac surgery with other comorbidities. Off-label administration of endotracheal rFVIIa permitted rapid safe control of massive pulmonary haemorrhage and prevented further detrimental decline in respiratory function with satisfactory outcome.

Massive intrathoracic haemorrhage as a complication of pulmonary parenchymal haemorrhage and anticoagulant treatment of lung embolization during COVID-19 – two case reports

The medical and social interest in the SARS-CoV-2 infection is currently high. This infection can, in severe cases, be accompanied by a series of complications, such as thromboembolic disease or pulmonary parenchymal haemorrhage. The paper presents two rare cases of massive intrathoracic haemorrhage caused by pulmonary parenchymal haemorrhage and exacerbated by full anticoagulant treatment of thromboembolic disease. In both cases, the haemorrhage originated in the left lower lobe and was life threatening, requiring urgent anatomical lung resection - left lower lobectomy. The combinaion of anticoagulant therapy and thromboembolic events related to COVID-19 can cause, in rare cases, massive pulmonary haemorrhage. This rare complication proved lethal in one out of two of the cases described in this paper. An imminent and adequate reaction is necessary when the first signs of haemorrhage appear.

Selumetinib for Refractory Pulmonary and Gastrointestinal Bleeding in Noonan Syndrome.

A 15-year-old-boy with Noonan syndrome and status post orthoptic heart transplant developed mixed mitral valve disease and underwent mechanical mitral valve replacement 6 months before presentation with acute respiratory distress. He developed massive pulmonary hemorrhage that required veno-venous extracorporeal membrane oxygenation (ECMO) support. He had a prolonged anticoagulation free ECMO course of 4 weeks, with ongoing recurrent pulmonary hemorrhage and underwent several rounds of coil embolization of aortopulmonary collaterals. ECMO course was complicated by significant nasopharyngeal bleeding that required embolization of the sphenopalatine artery. Shortly after decannulation, he developed massive gastrointestinal and peritoneal hemorrhage that was treated by embolization of the left gastric artery and a branch of the internal iliac artery. His bleeding was attributed to neo-angiogenesis. Initial treatment with propranolol was unsuccessful. Subsequent treatment with interferon α 2b demonstrated efficacy, but severe neutropenia required cessation of therapy. Because functional alterations of the rat sarcoma virus-mitogen activated protein kinase signaling pathway and protein tyrosine phosphatase nonreceptor type (PTPN11) mutations in Noonan syndrome are known to be associated with neo-angiogenesis, we used the mitogen-activated protein kinase inhibitor selumetinib as a gene-targeted therapy with the hope of controlling bleeding and inhibiting neo-angiogenesis. After initiation of selumetinib, bleeding stopped and allowed the patient to be discharged from the hospital on dipyridamole as antiplatelet prophylaxis for his mechanical mitral valve. He had no further bleeding episodes through 1 year after hospital discharge.

Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age

Objective To evaluate whether advanced maternal age (35–39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. Methods Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. Result Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. Conclusion AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.

Pulmonary thromboendarterectomy and pulmonary haemorrhage.

Pulmonary thromboendarterectomy surgery is the recommended treatment for patients with chronic thromboembolic pulmonary hypertension. Massive intraoperative pulmonary haemorrhage with bleeding into the airway is a rare complication, and it typically presents as cardiopulmonary bypass flow is reduced and blood begins to flow through the pulmonary circulation. Immediate management includes maintaining extracorporeal circulation to reduce blood flow through the pulmonary circulation, isolation of the affected lung, while the surgeon identifies and repairs the site of haemorrhage.

Effects of Ponderal Index on Neonatal Mortality and Morbidities in Extremely Premature Infants.

BackgroundTo evaluate how intrauterine stress affects extremely premature infants in terms of intrauterine growth restriction. We hypothesized that extremely premature infants with mildly-low ponderal index (MPI) would have better neonatal outcomes.MethodsWe selected 2,721 subjects of 23 to 28 weeks of gestation between 2013 and 2015 from Korean Neonatal Network database. They were divided into 4 groups based on ponderal index (PI) percentile; PI ≤ 3rd as severely-low PI (SPI, n = 82), 3rd < PI ≤ 10th as MPI (n = 190), 10th < PI ≤ 90th as adequate PI (API, n = 2,179), and PI > 90th as high PI (HPI, n = 270).ResultsThe mortality in MPI and API groups was comparable (16.3% vs. 16.9%). It was significantly lower than that in the SPI and HPI groups (30.5% and 24.9%, respectively; P = 0.001). The MPI and API groups had better neonatal morbidities compared with the SPI and/or HPI groups, while the MPI group (8.2%) showed a lower incidence of severe intraventricular hemorrhage (IVH) than the other groups (SPI, 21.3%; API, 15.0%; HPI, 19.7%, respectively; P = 0.004). The MPI group had a trend of a bottom in neonatal mortality and morbidities in extremely premature infants.ConclusionThe MPI and API groups had lower mortality, massive pulmonary hemorrhage, severe bronchopulmonary dysplasia or death, pulmonary hypertension and neonatal seizure rates than the SPI and/or HPI groups, while the MPI group showed a lower incidence of severe IVH than the other groups. We speculate that the lower incidence of neonatal morbidities and mortality in the MPI group indicating mild intrauterine stress might accelerate fetal maturation resulting in better outcomes in extremely premature infants.

Graves’ Thyrotoxicosis and Fulminant Myopericarditis: A Clinical Dilemma!

Abstract Myocarditis is a rare presentation of Graves’ disease, fulminant myocarditis is even rarer. We report a woman with Graves’ disease with fulminant myopericarditis as the presenting clinical feature. A 23-year-old healthy woman presented with acute onset pleuritic chest pain, palpitations, diaphoresis, heat intolerance, and dyspnea. There was no history of fever, upper respiratory tract infection, diarrhea, or weight loss. Physical exam revealed sinus tachycardia and palpable non-tender thyroid. Blood work was pertinent for TSH &amp;lt;0.01uIU/ml(0.3-4.5), free T4 2.8ng/dl(0.6-1.5), free T3 &amp;gt; 32.6pg/ml (2.4-4.2) and positive TSI (thyroid-stimulating immunoglobulin) 12.4 IU/L (&amp;lt;0.54). She had a diffusely enlarged vascular thyroid on ultrasound, all findings consistent with hyperthyroidism due to Graves’ disease. Electrocardiogram showed sinus tachycardia with diffuse PR depression and ST-segment elevation, troponin was 0.85 which increased to 17.5 within 12 hours, an echocardiogram showed normal ejection fraction (EF) with mild pulmonary hypertension but no pericardial effusion. She improved symptomatically with beta-blockers, methimazole, and colchicine but unfortunately had a witnessed ventricular fibrillation cardiac arrest in the next 12 hours with return to spontaneous circulation achieved after 90 minutes of bystander cardiopulmonary resuscitation. Coronary angiogram revealed normal coronaries with post-cardiac arrest EF of 5%. She subsequently developed acute respiratory distress syndrome secondary to massive pulmonary hemorrhage requiring extracorporeal mechanical support for worsening cardiogenic shock, succumbing to her illness a few hours later. Graves’ disease affects 0.5% of the population and causes hyperthyroidism in 50-80% of cases. Thyrotoxicosis may be associated with supraventricular arrhythmias and cardiomyopathy due to long-standing untreated hyperdynamic heart failure, but myopericarditis is an unusual presentation of Graves’ thyrotoxicosis with fulminant myopericarditis being even rarer. Fulminant myocarditis can present with ventricular tachyarrhythmias and can rapidly deteriorate into shock which may be difficult to distinguish from other causes of cardiogenic shock such as acute coronary syndromes or stress-induced cardiomyopathy. Myopericarditis associated with Graves’ is thought to be due to autoimmunity against functional TSH receptors identified in human cardiomyocytes. Fulminant myocarditis is a common cause of sudden cardiac death in young healthy adults, which is also the same population that gets Graves’ disease. It is critical to recognize the unusual presenting features of Graves’ disease such as fulminant myopericarditis, as timely aggressive intervention can reduce the risk of sudden cardiac death.

Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study.

BackgroundPulmonary hemorrhage is a potentially fatal event especially for preterm infants, which can lead to serious complications and even death. Many risk factors have been associated with the development of massive pulmonary hemorrhage. However, there is still no effective strategy to prevent massive pulmonary hemorrhage. The purpose of this study is to explore prediction model and survival strategies for massive pulmonary hemorrhage in premature infants.MethodsIn this retrospective study, we included all premature infants with birth weight <1,500 g who were hospitalized in our neonatal intensive care unit (NICU) between January 01 2010 and December 31 2019.ResultsOf 599 preterm infants, 51 developed massive pulmonary hemorrhage. The logistic regression analysis showed that patent ductus arteriosus [odds ratio (OR) =11.4, 95% confidence interval (CI): 4.79–27.0, P<0.0001], coagulopathy (OR =6.56, 95% CI: 2.83–15.2, P<0.0001), and 10-minute Apgar Score (OR =0.52, 95% CI: 0.37–0.73, P=0.0001) were risk factors for massive pulmonary hemorrhage. Whether or not surfactant is used, the positive predictive value of combined patent ductus arteriosus and coagulopathy for predicting massive pulmonary hemorrhage was 68.9% and 70.4%, respectively. Of the 51 preterm infants with massive pulmonary hemorrhage, 25 died and 26 survived. The survivors group had higher positive end-expiratory pressure compared with the deceased group after the onset of massive pulmonary hemorrhage. After adjusting for potential risk factors, the multiple logistic regression analysis showed that higher positive end-expiratory pressure levels are closely related to survival.ConclusionsPatent ductus arteriosus combined with coagulopathy has a high predictive value for massive pulmonary hemorrhage. Higher positive end-expiratory pressure levels may reduce mortality in massive pulmonary hemorrhage.

SHORT-TERM OUTCOME OF MASSIVE PULMONARY HEMORRHAGE IN PRETERM INFANTS IN TUZLA CANTON.

SUMMARYMassive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.