Pulmonary haemorrhage in neonates: Systematic review of management

Abstract

Aim: Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. Methods:A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes.Results: Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline.Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability.Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. Conclusion:There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.

Thrombocytopenia is more Frequent in Gram negative Neonatal Septicemia

“…It was noted that was not responsive to therapy, hence it is mostly preventable and ominous. Pulmonary hemorrhage in ventilated neonates can occur as a result of ventilation being initiated due to underlying respiratory problems (respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), and bronchopneumonia), particularly if associated with thrombocytopenia requiring platelet transfusion, and it is recommended to increase positive endexpiratory pressure (PEEP) in intermittent positive pressure ventilation (IPPV) or better to use high-frequency oscillatory ventilation (HFOV) (17).…”

Predictors of Bronchopulmonary Dysplasia in 625 Neonates with Respiratory Distress Syndrome

“…Intracranial hemorrhage stipulated a head CT or MRI scan or ultrasonogram that showed intracranial hemorrhage. Pulmonary hemorrhage (PH) is lungs’ angiorrhexis caused by an increased pressure on the capillaries of the alveolar wall due to a variety of factors, and the blood enters the lung tissue, which is characterized by sudden onset of frothy, pink-tinged secretions or discharge of bloody fluid from the upper respiratory tract or the endotracheal tube [ 22 ]. The present study protocol was approved by our Hospital Ethics Committee.…”

Ultra-slim flexible bronchoscopy-guided topical hemostatic drugs administration for the management of life-threatening refractory pulmonary hemorrhage in a preterm infant: Case report

“…Pulmonary hemorrhage (PH) is a rare, life-threatening complication in premature infants with respiratory distress syndrome. The incidence of PH is 3 to 11 per 1,000 live births with PH occurring most commonly within the first few days of life (1)(2)(3)(4)(5). PH is typically seen in neonates weighing less than 1500 g, who often have a patent ductus arteriosus (PDA), infection complication, trauma, have been treated with surfactant, and are ventilated (4,6,7).…”

“…The incidence of PH is 3 to 11 per 1,000 live births with PH occurring most commonly within the first few days of life (1)(2)(3)(4)(5). PH is typically seen in neonates weighing less than 1500 g, who often have a patent ductus arteriosus (PDA), infection complication, trauma, have been treated with surfactant, and are ventilated (4,6,7). Mortality rates of over 50% have been reported in premature infants (8), and as a result, PH does significantly increase the risk of later pulmonary or neurodevelopmental disabilities among those who survive (9,10).…”

“…There are several effective methods of managing PH in neonates, including surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine, and tolazoline (4). However, it remains challenging to diagnose and therapy precisely in refractory or focal PH cases.…”