A. Pappin et al., EXTENSIVE INTRAALVEOLAR PULMONARY HEMORRHAGE IN INFANTS DYING AFTER SURFACTANT THERAPY, The Journal of pediatrics, 124(4), 1994, pp. 621-626
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.