Introduction Pulmonary haemorrhage affects 1–5% of babies <32 weeks and is associated with respiratory distress syndrome (RDS), surfactant therapy and patent ductus arteriosus (PDA). Change to our surfactant protocol was associated temporally with increased cases of pulmonary haemorrhage. We reviewed the cases for causative factors.

Methods Affected in-born babies January 1st 2012 - March 31st 2013 were included. Demographic details and clinical data pre/post haemorrhage recorded.

Results 10/386 babies <32 weeks affected (2.5%). Details in Table.

All had RDS and received surfactant, 8 had repeated doses. Pulmonary haemorrhage occurred at median age of 36 h (IQR 33.75, 51.25 h). Prior to the haemorrhage all had significantly improved pulmonary function (ventilation pressures and oxygenation); three extubated. 6 had evidence of PDA, 3 had widened pulse pressure, 3 had systolic murmurs or echocardiographic evidence of PDA. After the haemorrhage all babies deteriorated with X-ray changes. One baby died. All 9 survivors developed clinically significant PDA requiring treatment. (1 duct ligation, 8 managed medically).

Conclusions All affected babies had a combination of risk factors for pulmonary haemorrhage. In addition they all exhibited a rapid improvement in ventilatory requirements lending weight to the the theory that falling pulmonary vascular resistance with increased pulmonary blood flow is a causative factor.