Neonatal Disease

Related factors analysis of clinical outcome after pulmonary hemorrhage in very low birth weight infants

  • Wen ZHU ,
  • Yunsu ZOU ,
  • Yue WU ,
  • Keyu LU ,
  • Rui CHENG ,
  • Meiling TONG ,
  • Yang YANG
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  • 1. Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu, China
    2. Department of Child Healthcare, Nanjing Maternal and Child Health Hospital, Nanjing 210000, Jiangsu, China

Received date: 2022-04-26

  Online published: 2023-10-08

Abstract

Objective To explore the important prognostic factors of pulmonary hemorrhage in very low birth weight (VLBW) infants. Methods The clinical data of VLBW infants diagnosed with pulmonary hemorrhage admitted to NICU from January 1, 2018 to December 31, 2021 were retrospectively analyzed. Results A total of 64 VLBW neonates were included, 39 in the death group and 25 in the survival group. In the death group, there were 21 neonates with gestational age <28 weeks, 17 with gestational age of 28-31+6 weeks, and 1 with gestational age of 32-33+6 weeks. There were 17 neonates with birth weight <1000 g, 13 with 1000-1250 g, and 9 with 1250-1500 g. Compared with the survival group, the death group had lower birth weight and gestational age, lower age of pulmonary hemorrhage occurrence, higher rates of gestational age <28 weeks and resuscitation by tracheal intubation, and higher rates of Ⅲ-Ⅳ respiratory distress syndrome, symptomatic ductus arteriosus and early-onset sepsis, with statistical significance (P<0.05). Compared with the survival group, the death group had higher peak inspiratory pressure within 24h after birth, higher fraction of inspired oxygen before pulmonary hemorrhage, and higher fraction of inspired oxygen and peak inspiratory pressure after pulmonary hemorrhage; In the death group, the proportion of arterial blood BE<-5mmol/L after birth was higher, and the proportion of arterial blood pH<7.1, BE<-5 mmol/L, PaCO2>50 mmHg was higher when pulmonary hemorrhage occurred; Prothrombin time (PT) and thrombin time were prolonged during pulmonary hemorrhage in the death group. The differences were statistically significant (P<0.05). Binary logistic regression analysis showed that resuscitation by tracheal intubation and PT≥30 s during pulmonary hemorrhage were independent risk factors for death in children with pulmonary hemorrhage (P<0.05). Log-rank test showed that the median survival time in the resuscitation group was shorter than that in the non-resuscitation group, and the median survival time in the PT≥30 s group was shorter than that in the PT<30 s group, the difference was statistically significant (P<0.001). Conclusions In clinical work, attention should be paid to the intrauterine hypoxia of VLBW infants, the reasonable application of tracheal intubation resuscitation after birth, and the active correction of coagulation dysfunction after bleeding, so as to reduce the mortality of pulmonary hemorrhage.

Cite this article

Wen ZHU , Yunsu ZOU , Yue WU , Keyu LU , Rui CHENG , Meiling TONG , Yang YANG . Related factors analysis of clinical outcome after pulmonary hemorrhage in very low birth weight infants[J]. Journal of Clinical Pediatrics, 2023 , 41(10) : 658 -664 . DOI: 10.12372/jcp.2023.22e0562

References

[1] Donda K, Vijayakanthi N, Dapaah-Siakwan F, et al. Trends in epidemiology and outcomes of respiratory distress syndrome in the United States[J]. Pediatr Pulmonol, 2019, 54(4): 405-414.
[2] Fauroux B, Hasco?t JM, Jarreau PH, et al. Risk factors for bronchiolitis hospitalization in infants: a French nationwide retrospective cohort study over four consecutive seasons (2009-2013)[J]. PLoS One, 2020, 15(3): e0229766.
[3] Tracy MK, Berkelhamer SK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity[J]. Pediatr Ann, 2019, 48(4): e148-e153.
[4] Omansky GL. Pulmonary hemorrhage in the neonate[J]. Neonatal Netw, 2019, 38(2): 109-112.
[5] Welde MA, Sanford CB, Mangum M, et al. Pulmonary hemorrhage in the neonate[J]. Neonatal Netw, 2021, 40(5): 295-304.
[6] Wang TT, Zhou M, Hu XF, et al. Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants[J]. World J Pediatr, 2020, 16(3): 299-304.
[7] Li J, Xia H, Ye L, et al. Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study[J]. Transl Pediatr, 2021, 10(5): 1324-1332.
[8] Tomaszewska M, Stork E, Minich NM, et al. Pulmonary hemorrhage: clinical course and outcomes among very low-birth-weight infants[J]. Arch Pediatr Adolesc Med, 1999, 153(7): 715-721.
[9] Yen TA, Wang CC, Hsieh WS, et al. Short-term outcome of pulmonary hemorrhage in very-low-birth-weight preterm infants[J]. Pediatr Neonatol, 2013, 54(5): 330-334.
[10] Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update[J]. Neonatology, 2019, 115(4): 432-450.
[11] SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, et al. Early CPAP versus surfactant in extremely preterm infants[J]. N Engl J Med, 2010, 362(21): 1970-1979.
[12] International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7): 991-999.
[13] Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm[J]. J Pediatr, 1978, 92(4): 529-534.
[14] Volpe JJ. Neurology of the newborn[M]. 5th ed. Philadelphia: Saunders, 2008: 541.
[15] Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging[J]. Ann Surg, 1978, 187(1): 1-7.
[16] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿[M]. 5版, 北京: 人民卫生出版社, 2019.
[17] 中国新生儿复苏项目专家组, 中华医学会围产医学分会新生儿复苏学组. 中国新生儿复苏指南(2021年修订)[J]. 中华围产医学杂志, 2022, 25(1): 4-12.
[18] 王晓晓, 陶立元, 裴敏玥, 等. 连续变量转换为分类变量的几种方法[J]. 中华儿科杂志, 2022, 60(5): 420-420.
[19] Garland J, Buck R, Weinberg M. Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study[J]. Pediatrics, 1994, 94(5): 719-723.
[20] Dufourq N, Thomson M, Adhikari M, et al. Massive pulmonary haemorrhage as a cause of death in the neonate-a retrospective review[J]. S Afr Med J, 2004, 94(4): 299-302.
[21] 董慧芳, 李文丽, 徐发林, 等. 河南省18家医院住院新生儿死亡情况调查[J]. 中华围产医学杂志, 2019, 22(6): 412-419.
[22] Bozkaya A, Yurttutan S, ?zkars MY, et al. Respiratory problems in preterm infants with pulmonary hemorrhage[J]. J Matern Fetal Neonatal Med, 2022, 35(25): 7505-7510.
[23] 肖雪, 卓美瑛, 张又祥, 等. 新生儿肺出血66例临床病理分析[J]. 实用儿科临床杂志, 2006, 21(6): 343-344.
[24] 陈丹, 黄西林, 李小萍, 等. 高频振荡通气治疗新生儿肺出血的临床研究[J]. 临床儿科杂志, 2011, 29(3): 212-215.
[25] 蔡栩栩, 毛健, 辛颖, 等. 新生儿肺出血支气管肺泡灌洗液SP-A及TNF-α的变化及其相关性研究[J]. 中国当代儿科杂志, 2005, 7(3): 198-201.
[26] Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns[J]. J Pediatr (Rio J), 2014, 90(3): 316-322.
[27] 花媛媛, 苗静琨, 邹仙, 等. 极早早产儿早发型败血症低风险人群临床特征分析[J]. 临床儿科杂志, 2019, 37(1): 1-5.
[28] Chen YY, Wang HP, Lin SM, et al. Pulmonary hemorrhage in very low-birthweight infants: risk factors and management[J]. Pediatr Int, 2012, 54(6): 743-747.
[29] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[30] Usemann J, Garten L, Bührer C, et al. Fresh frozen plasma transfusion - a risk factor for pulmonary hemorrhage in extremely low birth weight infants?[J]. J Perinat Med, 2017, 45(5): 627-633.
[31] Motta M, Del Vecchio A, Perrone B, et al. Fresh frozen plasma use in the NICU: a prospective, observational, multicentred study[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(4): F303-F308.
[32] Raban MS, Harrison MC. Fresh frozen plasma use in a neonatal unit in South Africa[J]. J Trop Pediatr, 2015, 61(4): 266-271.
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