Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre

摘要

Objective: Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival.Methods: Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group.Results: Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/73.610 versus 29 and 3/7 +/- 3.530 weeks, p=0.009) and lower one-minute (2.342 +/- 1.493 versus 4.035 +/- 2.079, p<0.001) and five-minute Apgar scores (2.342 +/- 1.493 versus 4.035 +/- 2.079, p<0.001) and required aggressive resuscitation (p=0.003) and a greater number of inotropes (2.195 +/- 1.346 versus 1.069 +/- 0.704, p<0.001). Deceased infants were administered increased amounts of fluid during the first 24h after birth (117.783 +/- 32.325 versus 99.379 +/- 17.728mL/kg, p=0.004). A relatively short prothrombin time impacted survival (p=0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p=0.01).Conclusion: Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.