Risk Factors and Outcomes of Pulmonary Hemorrhage in Preterm Infants born before 32 weeks

AbstractBackgroundPulmonary hemorrhage (PH) is a catastrophic event associated with significant morbidity and mortality among preterm infants. Understanding PH risk factors in preterm newborns, particularly those in low-to-middle-income countries like Vietnam, remains limited. This study aimed to investigate the risk factors and short-term outcomes of PH in very preterm infants.MethodsWe conducted an observational study of newborns aged < 72 hours with gestational age < 32 weeks, admitted to our unit from April 1, 2018 to March 31, 2019.ResultsOf 118 recruited newborns, 28 (23.7%) had PH. The logistic regression analysis showed that intubation within 24 first hours, blood transfusion, and coagulation disorders within the first 3 days were risk factors for PH (aOR = 4.594, 95% CI = 1.200-17.593; aOR = 5.394, 95% CI = 1.243-23.395 and aOR = 7.242 95% CI = 1.838-28.542, respectively). Intra-ventricular hemorrhage (IVH) and mortality rates were higher in patients with PH compared to those without (p<0.001). The length of invasive ventilation was longer in the PH group (p<0.001).ConclusionWe have identified intubation, blood transfusion, and coagulation disorders shortly after birth as risk factors for PH in very preterm infants, which was associated with increased mortality and occurrence of IVH.ImpactHigh incidence and mortality of pulmonary hemorrhage in preterm infants < 32 weeks’ gestational age with respiratory distress in a Neonatal Intensive Care Unit in Vietnam.Pulmonary hemorrhage should be considered in the clinical deterioration of preterm infants given invasive ventilation in the first 2-4 days of life.Independent risk factors for pulmonary hemorrhage: intubation in the first 24 hours, coagulation disorders, and transfusion of blood products in the first 3 days of life.Urgent need to seek diagnostic criteria for intraventricular hemorrhage as soon as pulmonary hemorrhage occurs.