EXTENSIVE INTRAALVEOLAR PULMONARY HEMORRHAGE IN INFANTS DYING AFTER SURFACTANT THERAPY

To assess the possible relationship between exogenous surfactant thera py and pulmonary hemorrhage in premature infants, we compared autopsy findings in 15 infants treated with exogenous surfactant and in 29 who died before the introduction of surfactant therapy. Infants who met t he following criteria were included: birth weight 501 to 1500 gm, surv ival 4 hours to 7 days, and no congenital anomalies. Average birth wei ght, gestational age, and age at death were equivalent for the two gro ups. High rates of pulmonary hemorrhage were present in both groups (t reated 80% vs untreated 83%). The untreated group had higher incidence s of interstitial hemorrhage and lung hematomas and significantly more large interstitial hemorrhages: 31% untreated versus O% treated (p<0. 05). The overall rate of intraalveolar hemorrhage was similar in the t wo groups, but surfactant-treated infants were more likely to have ext ensive intraalveolar hemorrhage: 53% versus 14% (p<0.05). Most surfact ant-treated infants who survived more than 24 hours had extensive intr aalveolar hemorrhage (8/9). Patients who had extensive intraalveolar h emorrhage, with or without prior surfactant therapy, frequently had cl inically significant pulmonary hemorrhage (7/12). These findings indic ate that infants who die after surfactant therapy have higher rates of a specific type of pulmonary hemorrhage-extensive intraalveolar hemor rhage.