Outcome following pulmonary haemorrhage in very low birthweightneonates treated with surfactant

摘要

AIM—To determine if pulmonary haemorrhage after surfactant treatment increases short and long term morbidity and mortality in neonates weighing <1500 g at birth.
METHODS—Neonates weighing <1500 g at birth who developed pulmonary haemorrhage after surfactant treatment were identified from a database. Based on the change in FIO2, pulmonary haemorrhage was classified as mild, moderate, or severe. Controls were matched for birthweight, gestational age, Apgar scores and hospital. Chronic lung disease (CLD) was defined as the need for supplemental oxygen at 36 weeks of corrected gestational age.
RESULTS—From January 1990 to May 1994, 94 of 787 (11.9%) neonates treated with surfactant developed pulmonary haemorrhage. Ten were excluded because of incomplete data or lack of controls. Eighty four were included for further analysis; two acceptable matches were found in 75, while only one match was possible in nine. For the pulmonary haemorrhage group, the mean (SD) birthweight was 917 (238) g, gestational age 27 (1.9) weeks. Pulmonary haemorrhage was severe in 39 (46%), moderate in 22 (26%), and mild in 23 (27%). Moderate and severe pulmonary haemorrhage were associated with chronic lung disease or death, OR 4.4 (confidence interval 1.3-15.7) and OR 7.8 (CI 2.6-28), respectively,while mild pulmonary haemorrhage was not, OR 1.8 (CI 0.55-5.8).pulmonary haemorrhage was associated with major intraventricularhaemorrhage (IVH), OR 3.1 (CI 1.5-6.4), but not with minor IVH, OR 1.3 (CI 0.6-2.6). In the survivors who could be assessed at ⩾2 years,the differences in neurodevelopmental outcome among the two groups werenot significant.
CONCLUSIONS—Inneonates treated with surfactant moderate and severe pulmonaryhaemorrhage is associated with an increased risk of death and shortterm morbidity. Pulmonary haemorrhage does not seem to be associatedwith increased long term morbidity.