Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns

Ferreira, Cristina Helena; Carmona, Fábio; Martinez, Francisco Eulógio

doi:10.1016/j.jped.2013.12.008

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Sumário

Original articles • J. Pediatr. (Rio J.) 90 (02) • May-Jun 2014 • https://doi.org/10.1016/j.jped.2013.12.008 copy

Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns^☆ ☆ Please cite this article as: Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014;90:316-22.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes.

METHODS:

this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200 g) and gestational age (± 1 week), with no previous pulmona ry hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed.

RESULTS:

the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns < 1,500 g, and 11% among newborns < 1,000 g. Intubation in the delivery room (OR = 7.16), SNAPPE II (OR = 2.97), surfactant use (OR = 3.7), and blood components used previously to pulmonary hemorrhage onset (OR = 5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR = 7.24). Among the survivors, the length of stay (p < 0.01) and mechanical ventilation time were longer (OR = 25.6), and oxygen use at 36 weeks of corrected age was higher (OR = 7.67).

CONCLUSIONS:

pulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution.

Pulmonary hemorrhage; Newborn; Prematurity; Blood components; Mortality

	Pulmonary hemorrhage (n = 67)	Controls (n = 67)	OR (95% CI)
Maternal use of corticosteroids	25 (37.3%)	33 (49.7%)	1.59 (0.8 to 3.1)
Maternal infection	16 (23.9%)	22 (32.8%)	1.53 (0.7 to 3.2)
Apgar 5th min < 7	19 (28.4%)	11 (16.5%)	2.01 (0.8 to 4.6)
Intubation in delivery room	59 (88.1%)	34 (50.8%)	7.16 (2.9 to 17.2)
Surfactant use	51 (76.1%)	31 (46.3%)	3.7 (1.7 to 7.7)
> than one dose of surfactant	23 (45.1%)	11 (35.5%)	4.7 (1.8 to 11.9)
SNAPPE II = 30	47 (71.2%)	30 (45.4%)	2.9 (1.4 to 6.1)
Patent ductus arteriosus	44 (65.7%)	39 (41.7%)	1.3 (0.6 to 2.7)
Previous use of indomethacin	6 (8.9%)	4 (5.9%)	1.5 (0.4 to 5.7)
Volume given 6 h before was inadequate	44 (65.6%)	36 (53.7%)	1.4 (0.6 to 2.7)
Use of volumetric expansion 6 h before	4 (5.9%)	2 (2.9%)	2.0 (0.3 to 11.6)
Use of blood products 6 h before	36 (53.7%)	11(16.4%)	5.9 (2.6 to 13.2)
Weight, grams (Mean ± SD)	864 ± 457	945 ± 455	p = 0.30
Gestational age, weeks (Mean ± SD)	28 ± 2.8	28.5 ± 2.8	p = 0.32
Female gender	58.2%	58.2%	p = 1
Small for gestational age	55.2%	44.8%	p = 0.18

	Adjusted OR 1 (95% CI)	Adjusted OR 2 (95% CI)	Adjusted OR 3 (95% CI)
Tracheal intubation	7.49 (1.94 to 28.89)	4.43 (1.46 to 13.48)	5.12 (2.04 to 12.8)
SNAPPE II = 30	1.10 (0.31 to 3.89)	0.95 (0.35 to 2.62)
Surfactant use	2.41 (0.9 to 6.47)	2.34 (0.98 to 5.57)
Patent ductus arteriosus	0.93 (0.37 to 2.37)
Inadequate volume	0.86 (0.35 to 2.18)
Blood products	4.18 (1.58 to 11.04)	3.79 (1.58 to 9.04)	4.2 (1.78 to 9.80)

	Crude OR (95% CI)	Adjusted OR (95% CI)
Time of mechanical ventilation = 10 days	25.7 (3.22 to 204.8)	33.1 (3.43 to 318.6)
Time of nasal CPAP = 10 days	2.44 (0.72 to 8.27)	3.35 (0.91 to 12.44)
Use of oxygen at 28 days	2.35 (0.82 to 6.73)	1.87 (0.60 to 5.82)
Use of oxygen at 36 weeks	7.67 (2.06 to 28.48)	8.23 (1.89 to 35.9)
PIVH Grades 3 and 4	3.57 (1.51 to 8.43)	2.48 (0.98 to 6.33)
Death	7.24 (3.33 to 15.73)	6.20 (2.74 to 14.04)
Time of hospital stay (days)^a(Mean ± SD)	110.8 ± 82.6	78 ± 66.4

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E-mail: jped@jped.com.br

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[1] * Corresponding author. crisfaleiros@usp.br

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Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns☆ ☆ Please cite this article as: Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014;90:316-22.

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSIONS:

Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns^☆ ☆ Please cite this article as: Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014;90:316-22.