Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant
Paresh B Pandita b, Karel O'Briena, Elizabeth Asztalosa c, Enza Coluccic, Michael S Dunna c
a Department of
Paediatrics University of Toronto Perinatal
Complex Toronto Ontario
Canada, b Children's
Regional Hospital at Cooper Hospital/University Medical Center
Camden NJ 08103 USA, c Department of Newborn and Developmental
Paediatrics Women's College Hospital
Toronto
Correspondence to: Dr Paresh Pandit. Email: pandit-paresh{at}cooperhealth.edu
Accepted 26 February
1999
AIM
To determine if
pulmonary haemorrhage after surfactant treatment increases short and
long term morbidity and mortality in neonates weighing <1500 g at birth.
METHODS
Neonates
weighing <1500 g at birth who developed pulmonary haemorrhage after
surfactant treatment were identified from a database. Based on the
change in FIO2, pulmonary haemorrhage was classified as
mild, moderate, or severe. Controls were matched for birthweight, gestational age, Apgar scores and hospital. Chronic lung disease (CLD)
was defined as the need for supplemental oxygen at 36 weeks of
corrected gestational age.
RESULTS
From January
1990 to May 1994, 94 of 787 (11.9%) neonates treated with surfactant
developed pulmonary haemorrhage. Ten were excluded because of
incomplete data or lack of controls. Eighty four were included for
further analysis; two acceptable matches were found in 75, while only
one match was possible in nine. For the pulmonary haemorrhage group,
the mean (SD) birthweight was 917 (238) g, gestational age 27 (1.9)
weeks. Pulmonary haemorrhage was severe in 39 (46%), moderate in 22 (26%), and mild in 23 (27%). Moderate and severe pulmonary
haemorrhage were associated with chronic lung disease or death, OR 4.4 (confidence interval 1.3-15.7) and OR 7.8 (CI 2.6-28), respectively,
while mild pulmonary haemorrhage was not, OR 1.8 (CI 0.55-5.8).
pulmonary haemorrhage was associated with major intraventricular
haemorrhage (IVH), OR 3.1 (CI 1.5-6.4), but not with minor IVH, OR 1.3 (CI 0.6-2.6). In the survivors who could be assessed at
2 years,
the differences in neurodevelopmental outcome among the two groups were
not significant.
CONCLUSIONS
In
neonates treated with surfactant moderate and severe pulmonary
haemorrhage is associated with an increased risk of death and short
term morbidity. Pulmonary haemorrhage does not seem to be associated
with increased long term morbidity.
Keywords: prematurity; respiratory distress syndrome; pulmonary haemorrhage
© 1999 by Archives of Disease in Childhood
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