479 - Pulmonary hemorrhage in preterm infants: Prevalence, risk factors and outcomes.

Poster Number: 479
Publication Number: 479.433

Tetyana H. Nesterenko, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Maliha Naeem, Cleveland Clinic Foundation, Cleveland Heights, OH, United States; Sabrina Ma, Cleveland Clinic, Cleveland, OH, United States; Vanishree Nandakumar, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Firas Saker, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States

Background: Pulmonary hemorrhage (PHEM) is a serious complication that is occasionally encountered in premature infants. There is a gap of knowledge to identify clinical setting and risk factors that precede the development of PHEM.   

Objective: The aim of this study was to describe premature infants that develop PHEM, provide their clinical data before PHEM occurs, and their outcomes after PHEM.  

Design/Methods: This was a retrospective case control study of preterm infants with gestational age (GA) < 32 weeks and birth weight (BW) < 1500g born over 11 years. All cases with PHEM were identified; control infants were matched for GA and BW. Clinical and laboratory data were collected in 12 hour epochs for 72 hours or until PHEM occurred. T-test, Mann-Whitney U test and Chi-squared tests were used to compare the two studied groups.

Results: A total of 1133 premature infants were identified; of them 36 (3.2%) had PHEM and 67 matched controls were used for comparisons. PHEM occurred at median (IQR) of 48 (34-120) hours. Maternal factors, mode of delivery and delivery room resuscitation did not differ between cases and controls (Table 1). Cases were more likely to receive second (89% vs 55%, p=0.002), third (66% vs 14%, p< 0.001), and fourth (20% vs 1%, p< 0.001) doses of surfactant. Table 2 presents respiratory and hemodynamics in the first 72 hours of life in both groups.  Infants with PHEM had more bilateral intraventricular hemorrhage (IVH) (36% vs 25%, p=0.014) and higher mortality (19% vs 3%, p=0.005).  Conclusion(s): Infants with PHEM did not differ from controls as regards maternal and perinatal factors, delivery room resuscitation, and postnatal management in the first 24hours of life.  Infants with PHEM were more likely to remain intubated and require higher FiO2 beyond 24 hours of life. PHEM is associated with IVH and mortality. A prospective study is needed to test the association of invasive mechanical ventilation and PHEM in premature infants.  
Table 1. Maternal, infant and delivery room resuscitation
Table 2. Respiratory and hemodynamics during first 72 hours of life