Neonatal Pulmonary Hemorrhage Research Articles

Cytomegalovirus pneumonia with intermittent pulmonary hemorrhage leading to asphyxia death: a case report and literature review

Neonatal pulmonary hemorrhage is a late manifestation of various diseases. Premature delivery and low body weight are frequently observed as high-risk factors, characterized by acute onset, rapid progression, and high mortality rates. Pulmonary hemorrhage caused by cytomegalovirus infection in newborns with normal immune function is a rare occurrence. This case report focuses on a term neonate with normal birth weight who presented solely with nasal obstruction shortly after birth. However, 4 days after birth, the newborn experienced a sudden onset of blood gushing from both the mouth and nasal cavity. The patient was diagnosed with gastrointestinal bleeding, neonatal pneumonia and neonatal lung consolidation. And he was discharged after ten days of symptomatic treatment. However, upon returning home, the patient experienced a sudden onset of bleeding from the mouth and nose, leading to his untimely demise. Subsequent autopsy revealed the presence of pulmonary hemorrhage in newborn, which presented as interstitial pneumonia. The cause of pulmonary hemorrhage is cytomegalovirus infection. This case emphasizes the importance of pediatricians enhancing their skills in differentiating pulmonary hemorrhage, especially from cytomegalovirus pneumonia.

Pulmonary Hemorrhage in Neonates with COVID-19

Introduction: The new coronavirus has been responsible for the recent pandemic. It mainly affects adults; however, children of all ages, including neonates, may also be affected. The disease has shown different manifestations and symptoms so far. Case Presentation: The present study reported four neonates with COVID-19 admitted to the neonatal intensive care unit. All neonates had positive PCR results and suffered from pulmonary hemorrhage during hospitalization. Conclusions: The clinical symptoms, laboratory findings, and imaging findings were severe in neonates with COVID-19 and pulmonary hemorrhage, possibly related to surfactant damage and degradation.

Risk Factors of Pulmonary Hemorrhage in Neonate

Introduction: Pulmonary haemorrhage (PH) is a potentially fatal respiratory complication of neonates, particularly those with very low-birth-weight infants (ELBWI), who are predisposed to diseases that need invasive ventilation and critical care after birth. Clinical PH is predicted to affect 1–12 out of every 1000 live babies [1]. Pulmonary haemorrhage is a potentially fatal disease that affects 1-12/1000 live births, with rates reaching 50/1000 births [2]. Objective: To determine the frequency of factors leading to pulmonary hemorrhage in neonates. Materials And Methods: This study was conducted at Ziauddin University Hospital, Karachi, Pakistan, and the duration of this study was from June 8, 2021 to December 7, 2021. All patients who fulfilled the inclusion criteria and visited to Pediatrics Department of Ziauddin Medical University, Karachi were included in the study. Informed consent was taken from parents / guardians after explaining the procedure, risks and benefits of the study. All of the patient data obtained included demographic information, clinical aspects, and information on mothers and infants. All data obtained were put into the accompanying proforma and utilized electronically for research purposes. Results: The age of mother was 29.6±7.8 years. In distribution of gender of baby, 63 (45%) were male, 77 (55%) were female. In distribution of factors leading to pulmonary hemorrhage, hypothermia was noted in 25 (17.8%) patients, heart failure in 42 (30.0%), disseminated intravascular coagulation (DIC) 12 (8.5%), oxygen saturation index 124 (88.6%), reduced mean platelet volume 111 (79.3%), polycythemia 20 (14.3%), patent ductus arterioses 22 (15.7%), low birth weight 97 (69.3%), respiratory distress syndrome in 44 (31.4%) while surfactant therapy was noted in 15 (10.7%) patients. Conclusion: It is to be concluded that oxygen saturation index and diabetes was noted as most common neonatal and mother factors respectively which leads to pulmonary hemorrhage in neonates. More prospective and well-controlled trials are needed to validate the current findings. Keywords: Factors, IUGR, Neonates, Pulmonary Hemorrhage

The Specific Signs of Lung Ultrasound to Diagnose Neonatal Pulmonary Hemorrhage

The Specific Signs of Lung Ultrasound to Diagnose Neonatal Pulmonary Hemorrhage

Analysis of the Application Effect of Predictive Nursing in Neonatal Pulmonary Hemorrhage

Analysis of the Application Effect of Predictive Nursing in Neonatal Pulmonary Hemorrhage

Additional Treatment with Low-Molecular-Weight Heparin Provides a Better Patient Outcome for Neonatal Pulmonary Hemorrhage with Unfractionated Heparin Treatment

Pulmonary hemorrhage occurring in preterm newborns is a catastrophic event and is significantly associated with neonatal deaths. Low-weight-molecular heparin is a medical agent usually used as anticoagulants during pregnancy and has the advantages of good absorption, long half-life, and high bioavailability. This study evaluated the pulmonary function and coagulation function in neonates with pulmonary hemorrhage following intravenous drip of low-molecular-weight heparin and the effects of low-molecular-weight heparin on serum prealbumin and retinol-binding protein levels. A total of 96 neonates with pulmonary hemorrhage were included as study subjects and arranged into the control group and the observation group, 48 per group, based on intravenous drip of unfractionated heparin with or without low-molecular-weight heparin. The neonates receiving intravenous drip of unfractionated heparin and low-molecular-weight heparin exhibited elevated partial pressure of oxygen (PaO2) concomitant with declined partial pressure of carbon (PaCO2) compared to those receiving unfractionated heparin treatment alone. With regard to pulmonary function, neonates receiving combined treatment of unfractionated heparin and low-molecular-weight heparin displayed increased forced expiratory volume in the first second (FEV1), FEV1/forced expiratory vital capacity (FVC), and peak expiratory flow (PEF) ( P < 0.05 ) when comparable to neonates receiving unfractionated heparin treatment alone. As for coagulation function, neonates with pulmonary hemorrhage had decreased activated partial thromboplastin time (APTT), prothrombin time (PT), thromboplastin time (TT), and fibrinogen (FIB) after treatment. Expectedly, these decreases were more significantly in neonates undergoing unfractionated heparin coupled with low-molecular-weight heparin ( P < 0.05 ). The control group was given unfractionated heparin, and the observation group was given unfractionated heparin coupled with low-molecular-weight heparin. In addition to pulmonary function and coagulation function, it was also observed that neonates undergoing unfractionated heparin coupled with low-molecular-weight heparin exhibited higher serum levels of serum prealbumin and retinol-binding protein than those treated with unfractionated heparin alone. Finally, higher recovery rate and lower incidence rate of complications, such as pulmonary infection, intracranial hemorrhage, and respiratory distress, were found in the observation group than the control group ( P < 0.05 ). In conclusion, additional treatment with low-molecular-weight heparin could provide a better patient outcome for neonatal pulmonary hemorrhage with unfractionated heparin treatment, as it could notably improve pulmonary function and coagulation function and reduce the incidence of complications.

Failure of non-invasive continuous positive airway pressure as the initial respiratory support in very preterm infants: a multicenter prospective cohort study

Objective: To analyze the risk factors and the adverse outcomes of failure in non-invasive continuous positive airway pressure (CPAP) as the initial respiratory support in very preterm infants with gestational age at birth <32 weeks. Methods: This multicenter prospective cohort study was conducted from January 1, 2019 to December 31, 2019 based on the data from Shandong Neonatal Network (SNN). Perinatal information, clinical treatment, and the short-term outcomes of very preterm infants with gestational age at birth of 25-31+6 weeks in 30 neonatal intensive care units (NICU) in SNN were collected. The very preterm infants with non-invasive CPAP as the initial respiratory support were divided into the group of non-invasive CPAP failure and the group of non-invasive CPAP success. The difference in the risk factors between the two groups were tested by χ2 test or Fisher exact and the Mann-Whitney U test, followed by Logistic regression analysis for all the risk factors with statistically significant difference. Results: A total of 1 040 very preterm infants were included in this study, including 577 males (55.5%) and 463 females (44.5%). There were 195 cases (18.8%) with gestational age of 25-28+6 weeks, 845 cases (81.2%) with gestational age of 29-31+6 weeks, 81 cases (7.8%) with birth weight<1 000 g and 959 cases (92.2%) with birth weight≥1 000 g. Overall, the rate of CPAP success (n=902, 86.7%) was higher than that of CPAP failure (n=138, 13.3%). The incidence of CPAP failure was 24.6% (48/195) and 10.7% (90/845) respectively for infants with gestational age of 25-28+6 weeks and of 29-31+6 weeks. The Logistic regression analysis showed that smaller gestational age at birth, maternal gestational hypertension disease, and severe respiratory distress syndrome (RDS, grade Ⅲ-Ⅳ) requiring pulmonary surfactant (PS) for more than twice and fraction of inspired oxygen (FiO2)>0.30 after birth were independent risk factors for the failure of initially used non-invasive CPAP (OR=0.718, 1.847, 4.003, 6.712, 1.948; 95%CI:0.590-0.873, 1.130-3.018, 2.435-6.579, 3.160-14.259, 1.189-3.192; all P<0.05). The incidence of adverse outcomes in the group of failure was significantly higher than in the group of success, including death, neonatal pulmonary hemorrhage, moderate or severe broncho pulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) (OR=4.436, 26.393, 1.998, 4.545; 95%CI:2.106-9.344, 9.690-71.885, 1.031-3.875, 1.615-12.795; all P<0.05). Conclusions: The very preterm infants with gestational age at birth<32 weeks have a higher incidence of major adverse outcomes after the failure of initially used non-invasive CPAP. Smaller gestational age at birth, maternal gestational hypertension disease and severe RDS (grade Ⅲ-Ⅳ) requiring PS for more than twice and FiO2>0.30 after birth are independent risk factors for the failure of initially used non-invasive CPAP.

Treatment of Acute Pulmonary Hemorrhage in Neonates with Endotracheal Ankaferd Blood Stopper Use

Treatment of Acute Pulmonary Hemorrhage in Neonates with Endotracheal Ankaferd Blood Stopper Use

The Clinical Experience of 37 Cases of Neonatal Pulmonary Hemorrhage

The Clinical Experience of 37 Cases of Neonatal Pulmonary Hemorrhage

Lung ultrasound for diagnosis of neonatal pulmonary hemorrhage

Pulmonary hemorrhage is a common critical disease in neonates, with high mortality. Early and accurate diagnosis is the key to successful treatment. Recently, lung ultrasound has been successfully used to diagnose neonatal pulmonary hemorrhage. Main ultrasonographic manifestations of neonatal pulmonary hemorrhage are described in this article, including shred sign, lung consolidation with air bronchogram, pleural effusion, lung edema, pleural line abnormality and A-line disappearance. Key words: Lung diseases; Hemorrhage; Infant, newborn; Ultrasonography

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

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,

Clinical study of high-frequency oscillatory ventilation in the treatment of pulmonary hemorrhage in newborn infants

Objective To investigate the effects of high frequency oscillatory ventilation in the treatment of neonatal pulmonary hemorrhage curative. Methods 56 neonates with pulmonary hemorrhage were selected, 28 cases in high frequency mechanical ventilation(HFOV) group and 28 cases in conventional mechanical ventilation(CMV) group.On the basis of conventional treatment, the HFOV group received high-frequency mechanical ventilation therapy, the CMV group treated with conventional ventilation.The breathing machine parameters of the two groups were observed and recorded, calculated oxygenation index(OI) and arterial/alveolar oxygen partial pressure ratio(a/APaO2). The duration of pulmonary hemorrhage, the duration of mechanical ventilation, the length of hospital stay, and the duration of oxygen therapy were compared between the two groups. Results Before treatment, there were no statistically differences of in OI and a/APaO2 between the two groups(t1=0.28, P1=0.78; t2=0.47, P2=0.64), 1h treatment later, declining value of the OI and the rising of a/APaO2 in surviving children, and the therapeutic effect of the HFOV group were more obvious than those of the CMV group(t1′=2.14, P1′=0.04; t2′=2.26, P2′=0.03). In the HFOV group, 23 cases cured(82.1%), 5 cases died(17.9%). And in CMV group, 15 cases cured(53.6%), 13 cases died(46.4%). The duration of pulmonary hemorrhage, the duration of mechanical ventilation, the length of the hospital stay, and the duration of oxygen therapy of the HFOV group were significantly lower than those of CMV group, the differences were statistically significant(P=0.046, 0.044, 0.048, 0.035). Conclusion HFOV can better improve oxygenation function in infants with pulmonary hemorrhage, shorten the course of the disease and improve the cure rate, recommend the application and clinical treatment. Key words: High-frequency ventilation; Acute lung injury; Hemorrhage; Infant, newborn

Risk factors for neonatal pulmonary hemorrhage in the neonatal intensive care unit of a municipal hospital

To investigate the risk factors for neonatal pulmonary hemorrhage (NPH) in the neonatal intensive care unit (NICU) of a municipal hospital, and to provide a basis for the early identification and treatment of NPH. A total of 112 neonates who were admitted to the NICU of Shaoyang Central Hospital of Hunan Province and diagnosed with NPH were enrolled as the case group. A nested case-control method was used to select, as a control group (n=224), the neonates who underwent the treatment with an assisted mechanical ventilator and did not experience pulmonary hemorrhage. Univariate analysis and unconditional logistic regression analysis were used to identify the high risk factors for NPH. The univariate analysis showed that compared with the control group, the case group had significantly higher incidence rates of gestational diabetes and cholestasis in mothers, cesarean delivery, gestational age <34 weeks, 5-minute Apgar score ≤5, birth weight <2 500 g, heart failure and disseminated intravascular coagulation (DIC) before the development of NPH, partial pressure of oxygen/fraction of inspired oxygen (oxygenation index, OI) ≤100, and a reduction in mean platelet volume. The multivariate logistic regression analysis showed that DIC, heart failure, and OI ≤100 were independent risk factors for NPH (OR=33.975, 3.975, 1.818 respectively; P<0.05). Heart failure, OI ≤100, and DIC are risk factors for the development of NPH in the NICU of the municipal hospital.

The causes of death of emergency patients in Xi'an Children's Hospital from 2009 to 2010

Objective To analyze the change of disease spectrum and the direct cause of death in Xi'an Children's Hospital emergency patients in the past 2 years.Methods The cases of death in 130 emergency cases from 2009 to 2010 were retrospectively analyzed.Results The main causes of death in 2009 were pneumonia,congenital heart disease,asphyxia,neonatal pulmonary hemorrhage and intracranial hemorrhage.Meanwhile,The main cause of death in 2010 were pneumonia,asphyxia,viral encephalitis,congenital heart disease and neonatal pulmonary hemorrhage,which significantly changed compared with 2009.Major direct causes of death were found:respiratory failure in 25 cases (27.5％),heart failure in 17 patients ( 18.7％ ),shock in 17patients ( 18.7％ ),asphyxia in 16 cases ( 17.5％ ),and hernia in 16 cases ( 17.5％ ),Conclusion In order to reduce the mortality rate of emergency patients,we should strengthen health care,actively manage pulmonary infection,systemic infection,and shock,control heart failure,and prevent aspiration. Key words: Emergency; Death disease spectrum; Children

Influence of RhoA-Rock pathway inhibitor on the filamentous actin of hypoxia human pulmonary microvascular endothelial cells

Objective To explore the control factor of pulmonary microvascular endothelial cells in pulmonary hemorrhage with the RhoA-Rock pathway inhibitors.Methods Human pulmonary rnicrovascular endothelial cells were conventionally cultured,and were divided into four groups:control group,inhibitor group,hypoxia group and hypoxia group with inhibitor.As different fluorescein lsothiocyanate-phalloidin and filamentous actin (F-actin) in cytoplasm combined,it issued red fluorescence.We observed the dynamic changes of F-actin by laser scanning confocal microscope in hypoxia human pulmonary microvascular endothelial cells and recorded the value of fluorescence.Results The mean fluorescence intensity of F-actin of hypoxia group in 1 h,12h and 24 h was (64.3 ±5.5)％,(60.3±4.2)％,and (47.8 ±4.6)％ as compared with the control group;the ratio of hypoxia group with inhibitor was (66.2 ±3.2)％,(67.1 ±6.2)％,and (72.5 ± 6.1 ) ％ as compared with the control group.The mean fluorescence intensity of F-actin decreased obviously after 1 h hypoxia treated to cells,decreasing to (64.3 ± 5.5 ) ％ of the control group (P ＜0.05 ) ;to 24 h,decreasing to (47.8 ±4.6) ％ of the control group(P ＜0.05).The mean fluorescence intensity of F-actin decreased to (66.2 ± 3.2) ％ of the control group after 1 h hypoxia treated in inhibitor group,which was more than 1 h in the hypoxic group.F-actin decreased obviously to (72.5 ± 6.1 ) ％ of the control group after 24 h hypoxia treated in inhibitor group.There was significant difference comparing with the hypoxia group after 24 h hypoxia(P ＜0.05).The mean fluorescence intensity of F-actin of inhibitor group without anoxic was invariant comparing with the control group(P ＞0.05).Cortex-like structure disappeared and the stress fibers arranged disorderly after hypoxia.Actin depolymedzated and broke gradually with the extension of hypoxia time.If to be hypoxic after pretreated with RhoA-Rock pathway inhibitor,cortex-like structure by the composition of pednuclear F-actin reappeared,distribution and arrangement of stress fibers in the cytoplasm tended to rule.Conclusion The RhoA-Rock pathway mediates the damage on F-actin of pulmonary microvascular endothelial cells after hypoxia.Interfering with the RhoA-Rock pathway inhibitors can provide a new direction for the treatment of neonatal pulmonary hemorrhage. Key words: Pulmonary hemorrhage; Pulmonary microvascular endothelial cell; Filament actin; RhoA-Rock pathway; Infant, newborn

Pathogenesis and death cause of neonatal pulmonary hemorrhage within postnatal 24h

Objective To investigate the pathogenesis and death cause of neonatal pulmonary hem orrhage (NPH) within postnatal 24 h and speculate their relation to fetal pulmonary hemorrhage. Methods To select the 114 cases of NPH within postnatal 24 h confirmed by pathological examination. According to the pathologic and clinic diagnosis materials, the pathogenesis and death cause of NPH within postnatal 24 h and their relation to fetal pulmonary hemorrhage were analyzed. Results Of the 114 cases with NPH,there were 6 cases of petechial pulmonary hemorrhage,60 cases of focal pulmonary hemorrhage and 48 cases of diffuse pulmonary hemorrhage. The discovery time of NPH were 28 cases at 0～6 h ,71 cases at 7～12 h and 15 cases at 13～24 h after birth. The pathogenesis in 114 cases of NPH could be divided into identical 2 major factors: 110 cases of the oxygen deficient factor consisting of amniotic fluid aspiration pneumonia( 62 cases) .hyaline membrane disease(24 cases) .complexity cyanotic congenital heart disease(7 cases),congenital pulmonary a-genesis(7 cases),neonatal asphyxia (7 cases),intracranial hemorrhage(2 cases) and hypoxic ischemic en-cephalopathy(1 cases) .respectively. Four cases were due to infection including sepsis which was caused by intrauterine infection. The death causes in 114 cases of NPH included hypoxia (113 cases) which consisted of pulmonary hemorrhage (74 cases) .amniotic fluid aspiration pneumonia(15 cases) .hyaline membrane dis-ease(12 cases),complexity cyanotic congenital heart disease(7 cases),congenital pulmonary agenesis(2 ca-ses) ,intracranial hemorrhage(2 cases) .neonatal asphyxia (1 cases) .and infectious factor(1 case) of sepsis which was caused by intrauterine infection. In 114 cases,82 cases had fetal distress,74 cases died from NPH directly including 3 cases with fetal distress died within a few minutes after birth. Conclusion Oxygen defi-cient is an important factor in pathogenesis and death cause of NPH within postnatal 24 h. The majority of ca-ses have the fetal distress and died from NPH directly in short time. Because of 3 cases NPH died within a few minutes after birth, therefore we conjecture that the most cases of NPH within postnatal 24 h may be a ex-tension of fetal pulmonary hemorrhage. Key words: Infant, newbom; Fetus; Pulmonary hemorrhage; Pathogenesis; Death cause

The risk factors and prognosis associated with neonatal pulmonary hemorrhage

Purpose: Although neonatal pulmonary hemorrhage is rare, it is associated with high mortality. We aimed to evaluate the risk factors associated with pulmonary hemorrhage in preterm infants and to describe the clinical course, including neonatal morbidity, of infants who developed pulmonary hemorrhage. Methods: We performed a retrospective case-control study of 117 newborn infants aged less than 37 gestational weeks admitted to the neonatal intensive care unit of Daegu Fatima Hospital between January 1995 and December 2008. Control group infants without pulmonary hemorrhage were matched according to the gestational age, duration of mechanical ventilation, and birth weight range ( 100 g). Pulmonary hemorrhage was defined as the presence of hemorrhagic fluid ≤ in the trachea and severe respiratory decompensation. Results :Pulmonary hemorrhage occurred in 17 cases of very low birth weight infants (VLBW; birth weight <1,500 g; median age, 3 days) and 22 cases of low birth weight infants (LBW; 1,500 g≤birth weight <2,500 g; median age, 1 day). Antenatal maternal glucocorticoid treatment significantly reduced the incidence of pulmonary hemorrhage in VLBW infants. Low APGAR score ( 3 at 1 min) and acidosis at birth were associated with significantly high incidence of pul ≤ mo- nary hemorrhage in LBW infants. Conclusion :Antecedent factors and timing of pulmonary hemorrhage of LBW infants were different from those of VLBW infants. The mortality rates of VLBW and LBW infants were 88.2% and 45.5%, respectively. Pulmonary hemorrhage was the principal cause of death in 66.6% VLBW infants and 40.0% LBW infants. (Korean J Pediatr 2010;53:503-509)

Change of serum tumor necrosis factor-α(TNF-α) in neonates with pulmonary hemorrhage

Objective To study the change of serum TNF-α in neonatal pulmonary hemorrhage.Methods We detected the levels of serum TNF-α in 36 cases of neonatal pulmonary hemorrhage and 40 cases of normal neonate. Results The level of serum TNF-α in neonate with pulmonary hemorrhage[ (15. 17±9. 21) ng/L] was significantly higher than that of normal neonate[(7. 26±5. 38) ng/L] (t =4. 5 ,P＜0. 005).Conclusion The level of serum TNF-α is increased in neonatal pulmonary hemorrhage,and it may involve in the process of neonatal pulmonary hemorrhage. Key words: Pulmonary hemorrhage; Neonate; Tumor necrosis factor-α

Clinical analysis of 52 cases neonatal pulmonary hemorrhage treated with mechanical ventilation

自2000年以来,我院NICU应用呼吸机常规机械通气治疗新生儿肺出血(NPH)52例,报道如下. 1 资料与方法 1.1 一般资料 52例经常规机械通气治疗的NPH患儿中,男40例(77%),女12例(23%),男∶女为3.33∶1;日龄＜24 h 40例(77%),～3d9例(17%),～7d2例(4%),＞7 d1例(2%);胎龄＜37周45例(87%),≥37周7例(13%);出生体重＜2 500 g 48例(92%),≥2 500 g 4例(8%)。

A Preterm Infant Who Has Acute Respiratory Decompensation

A 4-day-old preterm male infant presents with respiratory failure requiring 100% oxygen on assisted ventilation. ### Prenatal History: ### Birth History and Presentation: The infant was delivered by the vaginal route in vertex presentation. He had initial poor respiratory effort, but responded to warming, stimulation, and blow-by oxygen. Apgar scores were 7 at 1 minute and 8 at 5 minutes. He continued to demonstrate increased work of breathing and was intubated in the delivery room. He was admitted to the neonatal intensive care unit (NICU) for prematurity and respiratory distress. His birthweight was 1,589 g, which was appropriate for gestational age. Thirty minutes after birth, the patient had worsening tachypnea and subcostal retractions; chest radiograph at this time demonstrated diffuse bilateral reticular granular densities and microatelectasis CXR 1 . Oxygen saturation in room air was 78%. When 100% oxygen was administered, the oxygen saturation increased to 92%. Arterial blood gas (ABG) revealed: What is the appropriate treatment of this infant at this time? On arrival to the NICU, the patient was intubated and placed on mechanical ventilation. An echocardiogram revealed normal cardiac structure and function. The blood lactate level was elevated at 225.2 mg/dL (25 mmol/L). Blood ammonia concentration also was elevated at 518 mmol/L. Ketones were noted in the urine. ### Vital Signs Were: ### Physical Examination