Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant

Aim-To determine if pulmonary haemorrhage after surfactant treatment increa ses short and long term morbidity and mortality in neonates weighing <1500 g at birth. Methods-Neonates weighing <1500 g at birth who developed pulmonary haemorrh age after surfactant treatment were identified from a database. Based on th e change in FIO2, pulmonary haemorrhage was classified as mild, moderate, o r severe. Controls were matched for birthweight, gestational age, Apgar sco res and hospital. Chronic lung disease (CLD) was defined as the need for su pplemental oxygen at 36 weeks of corrected gestational age. Results-From January 1990 to May 1994, 94 of 787 (11.9%) neonates treated w ith surfactant developed pulmonary haemorrhage. Ten were excluded because o f incomplete data or lack of controls. Eighty four were included for furthe r analysis; two acceptable matches were found in 75, while only one match w as possible in nine. For the pulmonary haemorrhage group, the mean (SD) bir thweight was 917 (238) gestational age 27 (1.9) weeks. Pulmonary haemorrhag e was severe in 39 (46%), moderate in 22 (26%), and mild in 23 (27%). Moder ate and severe pulmonary haemorrhage were associated with chronic lung dise ase or death, OR 4.4 (confidence interval 1.3-15.7) and OR 7.8 (CI 2.6-28), respectively, while mild pulmonary haemorrhage was not, OR 1.8 (CI 0.55-5. 8). pulmonary haemorrhage was associated with major intraventricular haemor rhage (IVH), OR 3.1 (CI 1.5-6.4), but not with minor IVH, OR 1.3 (CI 0.6-2. 6). In the survivors who could be assessed at,greater than or equal to 2 ye ars, the differences in neurodevelopmental outcome among the two groups wer e not significant. Conclusions-In neonates treated with surfactant moderate and severe pulmona ry haemorrhage is associated with an increased risk of death and short term morbidity. Pulmonary haemorrhage does not seem to be associated with incre ased long term morbidity.