Association between pulmonary hemorrhage and CPAP failure in very preterm infants

Wang, Li; Zhao, Lili; Xu, Jia-ju; Yu, Yonghui; Li, Zhong-liang; Zhang, Feng-juan; Huang, Wen; Wu, Hai-huan; Deng, Liping; Yang, Haiyan; Li, Li; Ding, Lan-lan; Wang, Xiaokang; Zhang, Cheng-yuan; Wang, Hui

doi:10.3389/fped.2022.938431

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…According to the literature ( 13 ), bleeding into the lungs occurs mainly in premature newborns with severe lung disease. Risk factors have been proposed to be respiratory problems ( 14 ) and hemodynamically significantly increased blood flow (persistent ductus arteriosus, PDA) in the blood vessels in the lungs ( 15 ), like when sepsis impacts on hemodynamics and reopens or enlarges the patent ductus arteriosus. In newborns, infection ( 8 ), in accordance with our findings of sepsis and shock being highly associated with PH, as well as the association of PH with apnea of prematurity ( 16 ), is in line with the results of our study.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana

Gezmu,

Tefera,

Mochankana

et al. 2023

Front. Pediatr.

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IntroductionPulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting.Methods and materialsA cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student’s t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage.ResultThere were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%–5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage.ConclusionThis cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.

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Section: Discussionmentioning

confidence: 99%

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana

Gezmu,

Tefera,

Mochankana

et al. 2023

Front. Pediatr.

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“…A total of 251 studies were retrieved; after removing duplicates, initial screening and reading the full texts, a total of 13 studies were included [17][18][19][20][21][22][23][24][25][26][27][28][29] . The literature screening process is shown in Figure 1.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Factors influencing pulmonary hemorrhage in very low-and extremely low-birth-weight infants: a meta-analysis

Shi,

Tao,

et al. 2024

Preprint

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Background Pulmonary hemorrhage is a common complication in preterm infants, especially in very low-and extremely low-birth-weight infants, and has high morbidity and mortality rates. Although some studies have analyzed the epidemiological incidence of pulmonary hemorrhage and related factors, there are discrepancies between the results of these studies due to differences in study populations and study designs. Therefore, we conducted a meta-analysis of the factors affecting pulmonary hemorrhage to provide a reference for early clinical recognition and prevention of pulmonary hemorrhage. Methods Systematic searches of the PubMed, Embase, Cochrane Library and other databases were performed to extract the results of logistic regression analyses of case-control or cohort studies related to the factors affecting pulmonary hemorrhage in very-low and extremely-low-birth-weight infants. The data were analyzed using RevMan 5.3 software. Results A total of 13 studies were included and 11 influencing factors were screened through quantitative integration. All factors were statistically significant except for hypothermia: birth weight (OR=0.75, 95% CI 0.59-0.97, P=0.03, I2=95%), coagulation disorders (OR=4, 95% CI 1.79-8.93, P<0.01, I2=66%), patent ductus arteriosus (OR=3.52, 95% CI 1.71-7.27, P<0.01, I2=80%), mechanical ventilation (OR=2.94, 95% CI 1.94-4.45, P<0.01, I2=0%), aneaemia (OR=5.15, 95% CI 2.92-9.07, P<0.01, I2=43%), 5-min Apgar score (OR=1.6, 95% CI 1.21-2.11, P<0.01, I2=46%), early-onset sepsis (OR=2.71, 95% CI 1.62-4.53, P<0.01, I2=0%), antenatal steroids (OR=0.39, 95% CI 0.21-0.73, P<0.01, I2=25%), preterm birth (OR=1.99, 95% CI 1.34-2.97, P<0.01, I2=47%), and blood product transfusion (OR=6.16, 95% CI 2.15-17.69, P<0.01, I2=0%). Conclusion This study revealed the factors affecting pulmonary hemorrhage in very-low and extremely-low-birth-weight infants, and the results of the meta-analysis will be supplemented by a standardized cohort study based on this study. Trial registration PROSPERO (CRD42023465025)

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Development of a simplified model and nomogram for the prediction of pulmonary hemorrhage in respiratory distress syndrome in extremely preterm infants

Liu,

Tao,

Cai

et al. 2024

BMC Pediatr

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Background Pulmonary hemorrhage (PH) in respiratory distress syndrome (RDS) in extremely preterm infants exhibits a high mortality rate and poor long-term outcomes. The aim of the present study was to develop a machine learning (ML) predictive model for RDS with PH in extremely preterm infants. Methods We performed a retrospective analysis of extremely preterm infants with RDS at the Children’s Hospital of Soochow University between January 2015 and January 2021. We applied three ML algorithms—logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost)—to evaluate the performance of each model using the area under the curve (AUC), and developed a predictive model based on the optimal model. We calculated SHapley Additive exPlanations (SHAP) values to determine variables importance and show visualization results, and constructed a nomogram for individualized prediction. Results A total of 309 patients with RDS were enrolled, including 48 (15.5%) with PH. A total of 29 variables were collected, including demographic and clinical characteristics, laboratory data, and image classification. According to the AUC values, the RF model performed best (AUC = 0.868). Based on the SHAP values, the top five important variables in the RF model were gestational age, PaO 2 /FiO 2 , birth weight, mean platelet volume, and Apgar score at 5 min. Conclusions Our study showed that the RF model could be used to predict the risk of PH in RDS in extremely preterm infants. The nomogram provides clinicians with an effective tool for early warning and timely management.

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Association between pulmonary hemorrhage and CPAP failure in very preterm infants

Cited by 3 publications

References 25 publications

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana

Factors influencing pulmonary hemorrhage in very low-and extremely low-birth-weight infants: a meta-analysis

Development of a simplified model and nomogram for the prediction of pulmonary hemorrhage in respiratory distress syndrome in extremely preterm infants

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