Pulmonary hemorrhage - Clinical course and outcomes among very low-birth-weight infants

Objective: To describe the clinical course, neonatal morbidity, and neurode velopmental outcomes of very low-birth-weight (<1500 g) children who develo p pulmonary hemorrhage. Design: A retrospective case-control study in which 58 very low birth-weigh t infants who developed pulmonary hemorrhage during 1990 through 1994, of w hom 29 survived, were each matched to the next admitted infant who required mechanical ventilation for respiratory distress syndrome and was of the sa me sex, race, and birth weight (within 250 g). Setting: A regional tertiary neonatal intensive care unit and follow-up cli nic for high-risk infants at University Hospitals of Cleveland, Cleveland, Ohio. Main Outcome Measures: Survival, neonatal morbidity, and neurodevelopmental outcome at 20 months' corrected age. Results: Pulmonary hemorrhage occurred in 5.7% of the total population of v ery low-birth-weight infants. Despite similar severity of lung disease, sig nificantly more infants who developed pulmonary hemorrhage received surfact ant therapy compared with controls (91% vs 69%, P=.005). Infants with pulmo nary hemorrhage who died had a lower birth weight and gestational age compa red with those who survived (766 g vs 1023 g; 25 weeks vs 28 weeks, P<.001) and more received surfactant therapy (100% vs 83%, P=.05). Survivors with pulmonary hemorrhage did not differ significantly from controls in rates of oxygen dependence at 36 weeks corrected age (52% vs 38%), grade 3 to 4 per iventricular hemorrhage (28% vs 17%), or necrotizing enterocolitis (3% vs 7 %), but tended to have more seizures (24% vs 3%, P = .05), periventricular leucomalacia (17% vs 0%, P = .06), and patent ductus arteriosus (79% vs 55% , P = .09). There were no significant differences in neurodevelopmental out comes at 20 months' corrected age, (cerebral palsy, 16% vs 14%; subnormal [ <70] Bayley Mental Developmental Index, 59% vs 43%; and deafness, 13% vs 10 %). Conclusion: Although mortality is high, pulmonary hemorrhage does not signi ficantly increase the risk of later pulmonary or neurodevelopmental disabil ities among those who survive.