Newborn

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  3 (2024)
Volume  2 (2023)
Volume  1 (2022)
Related articles

VOLUME 3 , ISSUE 4 ( October-December, 2024 ) > List of Articles

ORIGINAL RESEARCH

Pulmonary Hemorrhage Management Practices in Extremely Preterm Infants: A Global Survey

Pratibha Thakkar, Venkata Raju, Prasanth Raju, Vinayak Govande, Chintan Gandhi, Kartikeya Makker, Ranjit Torgalkar, Rani A Bashir, Sharada Gowda, Naveed Hussain, Kaashif Ahmad

Keywords : Management, Neonates, Patent ductus arteriosus, Pulmonary hemorrhage, Preterm infants, Risk factors, Surfactant

Citation Information : Thakkar P, Raju V, Raju P, Govande V, Gandhi C, Makker K, Torgalkar R, Bashir RA, Gowda S, Hussain N, Ahmad K. Pulmonary Hemorrhage Management Practices in Extremely Preterm Infants: A Global Survey. 2024; 3 (4):257-262.

DOI: 10.5005/jp-journals-11002-0113

License: CC BY-NC 4.0

Published Online: 20-12-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Pulmonary hemorrhage (PHEM) can be life-threatening in extremely premature infants, with only supportive treatment available. Little is known regarding specific management strategies for PHEM because of the rarity of its occurrence and significant associated mortality. Materials and methods: A multi-institutional working group of physicians was created with the common goal of expanding knowledge about PHEM. We designed a 14-question survey around our experience and current controversies reported in the literature. The survey was circulated via neonatal listservs (MEDNAX neonatology forum, nicu99, Envision Physician Services, and the AAP Training and Early Career neonatologists’ group) to capture the management strategies of various neonatologists practicing under different settings and resources. Smartphone Apps for the Global Newborn Society were also used to reach neonatal providers around the world. The data were collected in REDCap software, and statistical analysis was conducted using SPSS version 27. Results: There were 360 responses from 73 countries. Most neonatologists (79.2%) managed PHEM without unit-based guidelines. For the management of PHEM, there was a consensus on using endotracheal (ET) epinephrine, blood products and high-frequency oscillatory ventilation after acute PHEM. More participants responded using surfactant replacement after (55.6%) rather than during (33.1%) the management of PHEM. Post PHEM, most neonatologists obtain echocardiograms (66%) and consider treatment for patent ductus arteriosus (PDA) (65%), with the majority using acetaminophen (56.4%). Comparative analysis of practices in North America and other NICUs are also reported. Conclusions: Our study provides a global overview of experience, and opinion-based practices used in the management of PHEM and reflects on the lack of available algorithms. Creating high-quality, evidence-based guidelines is necessary to provide appropriate care and reduce heterogeneity in the management.

PDF Share
  1. Lee M, Wu K, Yu A, et al. Pulmonary hemorrhage in neonatal respiratory distress syndrome: Radiographic evolution, course, complications and long-term clinical outcomes. J Neonatal Perinatal Med 2019;12(2):161–171. DOI: 10.3233/NPM-1867.
  2. Barnes ME, Feeney E, Duncan A, et al. Pulmonary haemorrhage in neonates: Systematic review of management. Acta Paediatr 2022;111(2):236–244. DOI: 10.1111/apa.16127.
  3. Hadžić D, Zulić E, Salkanović-Delibegović S, et al. Short-term outcome of massive pulmonary hemorrhage in preterm infants in tuzla canton. Acta Clin Croat 2021;60(1):82–88. DOI: 10.20471/acc.2021.60.01.12.
  4. Ahmad KA, Bennett MM, Ahmad SF, et al. Morbidity and mortality with early pulmonary haemorrhage in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2019;104(1):F63–F68. DOI: 10.1136/archdischild-2017-314172.
  5. Olomu N, Kulkarni R, Manco-Johnson M. Treatment of severe pulmonary hemorrhage with activated recombinant factor VII (rFVIIa) in very low birth weight infants. J Perinatol 2002;22(8):672–674. DOI: 10.1038/sj.jp.7210787.
  6. Chen D, Wang M, Wang X, et al. [High-risk factors and clinical characteristics of massive pulmonary hemorrhage in infants with extremely low birth weight]. Zhongguo Dang Dai Er Ke Za Zhi 2017;19(1):54–58. DOI: 10.7499/j.issn.1008-8830.2017.01.008.
  7. Chen YY, Wang HP, Lin SM, et al. Pulmonary hemorrhage in very low-birthweight infants: risk factors and management. Pediatr Int 2012;54(6):743–747. DOI: 10.1111/j.1442-200X.2012.03670.x.
  8. Fan J, Hei MY, Huang XL, et al. [Risk factors for neonatal pulmonary hemorrhage in the neonatal intensive care unit of a municipal hospital]. Zhongguo Dang Dai Er Ke Za Zhi 2017;19(3):346–349. DOI: 10.7499/j.issn.1008-8830.2017.03.019.
  9. Lin XZ, Lai JD, Lv M, et al. [Clinical efficacy of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal pulmonary hemorrhage]. Zhongguo Dang Dai Er Ke Za Zhi 2015;17(4):345–349. PMID: 25919553.
  10. Pan WW, Tong XM. [Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016]. Zhongguo Dang Dai Er Ke Za Zhi 2018;20(4):255–260. DOI: 10.7499/j.issn.1008-8830.2018.04.001.
  11. Shi Y, Tang S, Li H, et al. New treatment of neonatal pulmonary hemorrhage with hemocoagulase in addition to mechanical ventilation. Biol Neonate 2005;88(2):118–121. DOI: 10.1159/0000 85826.
  12. Shi Y, Zhao J, Tang S, et al. Effect of hemocoagulase for prevention of pulmonary hemorrhage in critical newborns on mechanical ventilation: A randomized controlled trial. Indian Pediatr 200845(3):199–202. PMID: 18367764.
  13. Lin TW, Su BH, Lin HC, et al. Risk factors of pulmonary hemorrhage in very-low-birth-weight infants: A two-year retrospective study. Acta Paediatr Taiwan 2000;41(5):255–258. PMID: 11100523.
  14. Raju TN, Langenberg P. Pulmonary hemorrhage and exogenous surfactant therapy: A metaanalysis. J Pediatr 1993;123(4):603–610. DOI: 10.1016/s0022-3476(05)80963-1.
  15. van Houten J, Long W, Mullett M, et al. Pulmonary hemorrhage in premature infants after treatment with synthetic surfactant: An autopsy evaluation. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group. J Pediatr 1992;120(2 Pt 2):S40–S44. DOI: 10.1016/s0022-3476(05)81232-6.
  16. Pandit PB, Dunn MS, Colucci EA. Surfactant therapy in neonates with respiratory deterioration due to pulmonary hemorrhage. Pediatrics 1995;95(1):32–36. PMID: 7770305.
  17. Amizuka T, Shimizu H, Niida Y, et al. Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema. Eur J Pediatr 2003;162(10):697–702. DOI: 10.1007/s00431-003-1276-x.
  18. Finer NN. Surfactant use for neonatal lung injury: Beyond respiratory distress syndrome. Paediatr Respir Rev 2004;5 Suppl A:S289–S297. DOI: 10.1016/s1526-0542(04)90053-x.
  19. Aziz A, Ohlsson A. Surfactant for pulmonary haemorrhage in neonates. Cochrane Database Syst Rev 2020;2(2):Cd005254. DOI: 10.1002/14651858.CD005254.pub4.
  20. Orbach R, Mandel D, Lubetzky R, et al. Pulmonary hemorrhage due to Coxsackievirus B infection-A call to raise suspicion of this important complication as an end-stage of enterovirus sepsis in preterm twin neonates. J Clin Virol 2016;82:41–45. DOI: 10.1016/j.jcv.2016.07.003.
  21. Wang TT, Zhou M, Hu XF, et al. Perinatal risk factors for pulmonary hemorrhage in extremely low-birth-weight infants. World J Pediatr 2019;16(3):299–304. DOI: 10.1007/s12519-019-00322-7.
  22. Thach R, Gitto L. Neonatal sepsis due to Coxsackievirus B3 complicated by liver failure and pulmonary hemorrhage. Case Reports in Perinatal Medicine 2022;11(1):20210085. DOI: 10.1515/crpm-2021-0085.
  23. Yang C, Ge Q, Huo X, Ge C. Cytomegalovirus pneumonia with intermittent pulmonary hemorrhage leading to asphyxia death: A case report and literature review. Virology Journal 2024;21:131. DOI: 10.1186/s12985-024-02399-7.
  24. Alassaf A, Ellithy K, Mehta T, et al. Severe pulmonary hemorrhage in a 3-week-old neonate with COVID-19 infection: A case report. Clin Case Rep 2022;10(8):e6189. DOI: 10.1002/ccr3.6189.
  25. Vahedi Z, Mousavi A, Behmadi R. Pulmonary hemorrhage in neonates with COVID-19. International Journal of Infection 2023;10(1):e139115. DOI: 10.5812/iji-139115.
  26. Bhandari V, Gagnon C, Rosenkrantz T, et al. Pulmonary hemorrhage in neonates of early and late gestation. J Perinat Med 1999;27(5):369–375. DOI: 10.1515/JPM.1999.050.
  27. Cetin H, Yalaz M, Akisu M, et al. The use of recombinant activated factor VII in the treatment of massive pulmonary hemorrhage in a preterm infant. Blood Coagul Fibrinolysis 2006;17(3):213–216. DOI: 10.1097/01.mbc.0000220245.20036.2d.
  28. Cosar H, Isik H, Cakır SC, et al. Recombinant activated factor VIIa (rFVIIa) treatment in very-low-birth-weight (VLBW) premature infants with acute pulmonary hemorrhage: A single-center, retrospective study. Paediatr Drugs 2017;19(1):53–58. DOI: 10.1007/s40272-016-0203-3.
  29. Diaz R, Almeida P, Alvarez M, et al. Life-threatening pulmonary hemorrhage responds to recombinant factor VIIa: A case series in south florida hospitals. Cureus 2019;11(11):e6202. DOI: 10.7759/cureus.6202.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.