Pulmonary Hemorrhage in Extremely Low Birth Weight Infants: Risk Factors and Preventive Measures for an Increased Incidence.

BACKGROUND

Pulmonary hemorrhage is a severe respiratory complication with high mortality in preterm infants; no causal treatment exists. This study aimed to identify risk factors for pulmonary hemorrhage in extremely low birth weight infants (birth weight <1,000 g) treated in a German neonatal unit and to relate these factors to a local three-fold increase in pulmonary hemorrhage incidence over 10 years.

PATIENTS AND

METHODS

In this retrospective cohort study spanning approximately 10 years, 319 extremely low birth weight infants (including 12 with pulmonary hemorrhage) were divided into low- and high-incidence periods. Perinatal characteristics and therapeutic measures were recorded, and associations between risk factors, time period, and pulmonary hemorrhage incidence were analyzed statistically.

RESULTS

Multiple gestation (odds ratio: 23.83), small for gestational age (odds ratio: 7.01), a low 1-minute Apgar score (odds ratio: 1.57 per 1-point decrease), and higher fluid intake during the first 2 days of life (odds ratio: 1.36 per additional 10 mL/kg/d) were independent risk factors for pulmonary hemorrhage.

DISCUSSION AND

CONCLUSIONS

A 1.5-fold increase in the small for gestational age rate over the study period may have contributed to the increased pulmonary hemorrhage incidence. Comparison of low- and high-incidence periods further suggested possible associations between an initial surfactant dose and use of binasal CPAP (Continous Positive Airway Pressure) devices. Based on these findings, a five-point catalog of preventive measures was developed.