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

Abstract

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.