Aims To study the clinical course, associated neonatal morbidity and mortality following pulmonary haemorrhage (PH) in VLBW infants.
Methods Infants < 1500gms that developed pulmonary haemorrhage were identified from the hospital database. Outcome was measured as death or survival following acute PH.
Results Total of 1206 VLBW infants were admitted in our NICU between 2002 to 2011. Incidence of PH was 3%(n=40) in this group. Mean gestational age (SD) was 26±1.8 weeks with mean Birth weight of 0.8±0.2 kg. Cause of preterm delivery was fetal distress n=7, maternal PET n=8, maternal sepsis n=10 and preterm labour n=10. Eleven of those mothers received antenatal steroids. Antenatal steroids were associated with improved survival (p<0.001). Eight babies had evidence of intrauterine growth retardation and six babies were septic at birth. Five patients required cardiopulmonary resuscitation at birth. The mean age at PH was 47.7±28 hours. Sixteen patients received prophylactic surfactant. Two patients had mild, nine had moderate and twenty-nine had severe PH. Ten cases were treated with surfactant with acute PH. Half of the infants had a PDA. Eighteen patients were coagulopathic at the time of PH. Twenty-one babies died (53%) and none had received antenatal steroids. In the surviving infants, ten developed CLD and six had Mental Developmental Index <70.
Conclusion Our institutional incidence of pulmonary haemorrhage and outcome is similar to other reports in the literature. Comprehensive evidence base management strategies are required to standardise care of the VLBW infants who develop PH.