Pulmonary hemorrhage and exogenous surfactant therapy: A metaanalysis

Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in low birth weight premature infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Exogenous surfactant therapy has become well established in newborn infants with respiratory distress. Many aspects of its use have been well evaluated in high-quality trials and systematic reviews. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/ sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This article summarizes the evidence and gives recommendations for the use of surfactant therapy for respiratory distress syndrome (RDS) in newborn.Bangladesh J Child Health 2016; VOL 40 (1) :26-30

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Surfactant Therapy In Neonates With Respiratory Deterioration Due to Pulmonary Hemorrhage

PEDIATRICS ◽

10.1542/peds.95.1.32 ◽

1995 ◽

Vol 95 (1) ◽

pp. 32-36

Author(s):

Paresh B. Pandit ◽

Michael S. Dunn ◽

Enza A. Colucci

Keyword(s):

Repeated Measures ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Case Series ◽

Pulmonary Hemorrhage ◽

Oxygenation Index ◽

Surfactant Therapy ◽

Exogenous Surfactant ◽

Retrospective Case ◽

Clinically Significant

Objective. To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage. Design. Retrospective case series. Setting. Three regional neonatal intensive care units. Methods. Infants who received surfactant following a clinically significant pulmonary hemorrhage during the time period July 1991 to December 1993 were identified from a database. Infants were excluded if any other cause was found to explain their deterioration. The primary outcome was change in respiratory status following surfactant therapy, as reflected by oxygenation index (OI) and arterial/Alveolar oxygen ratio. Data points were taken as averages of 3 through 6 hours and 0 through 3 hours for the 6 hours before and after surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. Fifteen patients fulfilled inclusion criteria. Median values (range): birth weight, 960 g (595 to 4045); age at pulmonary hemorrhage, 24.4 hours (0.3 to 62); and interval between pulmonary hemorrhage and surfactant therapy, 10 hours (3.7 to 46.5). Mean OI improved from 24.6, at 0 to 3 hours presurfactant, to 8.6 at 3 to 6 hours postsurfactant (P .001). No patient deteriorated following surfactant therapy. The primary respiratory diagnosis was respiratory distress syndrome (RDS) in 8, meconium aspiration syndrome in 3, and isolated pulmonary hemorrhage in 4. All those with RDS had also received surfactant before their pulmonary hemorrhage. Conclusions. Exogenous surfactant appears to be useful adjunctive therapy in neonates with a clinically significant pulmonary hemorrhage. Its use for this indication should be further investigated by a randomized controlled trial.

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Pulmonary Hemorrhage in the Neonate

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/11-t-696 ◽

2021 ◽

Vol 40 (5) ◽

pp. 295-304

Author(s):

Megan Alexandra Welde ◽

Cassidy Brooke Sanford ◽

Melissa Mangum ◽

Christy Paschal ◽

Amy J. Jnah

Keyword(s):

Early Identification ◽

Diagnostic Testing ◽

Pulmonary Hemorrhage ◽

Underlying Disease ◽

Morbidity And Mortality ◽

Current Evidence ◽

Exogenous Surfactant ◽

Significant Morbidity ◽

Proactive Management ◽

Surfactant Administration

Pulmonary hemorrhage (PH) is a pathology associated with significant morbidity and mortality, particularly among preterm infants in the NICU. The diagnosis is made when hemorrhagic secretions are aspirated from the trachea concurrent with respiratory decompensation that necessitates intubation or escalated support. The implementation of mechanical ventilation and widespread exogenous surfactant administration have significantly reduced respiratory morbidities. However, when PH develops, death remains the most common outcome. Treatment for PH remains primarily supportive; thus, a thorough understanding of underlying disease processes, manifestations, diagnostic testing, and current evidence is vital to enable early identification and proactive management to reduce morbidity and mortality.

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Pulmonary Hemorrhage Risk in Infants With a Clinically Diagnosed Patent Ductus Arteriosus: A Retrospective Cohort Study

PEDIATRICS ◽

10.1542/peds.94.5.719 ◽

1994 ◽

Vol 94 (5) ◽

pp. 719-723 ◽

Cited By ~ 2

Author(s):

Jeffery Garland ◽

Rosanne Buck ◽

Michelle Weinberg

Keyword(s):

Cohort Study ◽

Patent Ductus Arteriosus ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Ductus Arteriosus ◽

Ventilatory Support ◽

Pulmonary Hemorrhage ◽

Surfactant Therapy ◽

Artificial Surfactant ◽

Patent Ductus

Objective. To determine if an early, dinically detectable patent ductus arteriosus (FDA) was associated with pulmonary hemorrhage (PH) in infants who received rescue artificial surfactant therapy. Methods. This retrospective cohort study of 233 low birth weight infants (≤ 1700 g) who received artificial surfactant therapy for respiratory distress syndrome compared antenatal and postnatal characteristics of infants with PH and without PH. Pulmonary hemorrhage was defined by an onset of bright red blood from the endotracheal tube in quantities that resulted in increased ventilatory support and a new infiltrate on a chest radiograph. Results. Pulmonary hemorrhage occurred in 6% (15/233) of the infants. Thirty-three percent (5/15) of the infants with PH died within 14 days of the hemorrhage. Of the 15 PH, 73% occurred within 48 hours of the first surfactant dose. Pulmonary hemorrhage was more common in male infants and infants of mothers who received antibiotic therapy during labor (P ≤ .04). Infants with PH received surfactant earlier than those without PH (P = .04). Nursery events or therapies occurring following surfactant therapy that were associated with PH included: little improvement in ventilatory efficiency index (P = .01), dopamine infusion (P = .04), and the presence of a clinically detectable PDA before, or at the time of, the PH [60% (9/15) vs 33% (71/217), P = .03]. After adjusting for severity of illness before surfactant therapy, risk of PH remained greater in infants who developed symptoms of a PDA. Dopamine support appeared to modify the association between PDA and PH. Conclusions. In this retrospective cohort study, pulmonary hemorrhage was associated with the presence of a clinically detectable patent ductus arteriosus before, or at the time of, pulmonary hemorrhage.

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