Pulmonary hemorrhage in deceased infants - Baseline data for further studyof infant mortality

Infant lung samples were obtained at autopsy by medical examiner pathologis ts in five areas of the United States regardless of the cause of death. Lun g sections were stained with hematoxylin and eosin. Sixty cases were evalua ted for the study. The four sections examined fur each case were taken from the anterior and posterior aspects of the right and left upper lung lobes. Histologic sections were scored for the extent of alveolar hemorrhage usin g the following scoring system: 0, no hemorrhage; i, focal hemorrhage but l ess than score 2; 2, patchy, focal hemorrhage not present throughout the se ction; 3, focal hemorrhage more extensive than score 2 but not meeting the criteria for score 4; 4, patchy focal hemorrhage distributed throughout the section; 5, more extensive hemorrhage than score 4 but not meeting the cri teria for score 6; 6, diffuse hemorrhage throughout the section. Total poss ible scores ranged from 0 to 24. Intraalveolar hemorrhage was observed in 4 0 cases. Overall, the mean score for the 60 cases was 5 (range, 0-24); for the 40 cases with hemorrhage, 7 (range, 1-24). Scores were compared with ot her descriptive variables like cause of death; interval between onset of fa tal events and death; whether resuscitation was attempted; and pulmonary ma crophage counts and hemosiderin scores reported in earlier studies of the s ame cases. In none of the 60 cases was death attributed to pulmonary hemorr hage or hemosiderosis. Pulmonary hemorrhage tends to be common among deceas ed infants; more prominent when there is medical treatment or resuscitation during the agonal period; infant position may partially explain distributi on of hemorrhage in lungs; postmortem interval may exacerbate pulmonary hem orrhage; and infant deaths caused by acute idiopathic pulmonary hemorrhage (AIPH) or pulmonary hemorrhage/hemosiderosis (PHH) probably are rare. Speci fic case definitions for AIPH and PHH are needed, along with further study of these conditions.