Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Pediatr Neonatol. 2013 Oct;54(5):330-4. doi: 10.1016/j.pedneo.2013.04.005. Epub 2013 May 24.
Severe pulmonary hemorrhage is a serious complication with a high mortality rate in preterm infants with respiratory distress syndrome (RDS) after surfactant therapy. The aim of this study is to evaluate the efficacy of our current management strategy for neonates with severe pulmonary hemorrhage.
Very-low-birth-weight (VLBW) infants who developed severe pulmonary hemorrhage were studied from January 2006 to August 2011. Treatment for severe pulmonary hemorrhage in our neonatal intensive care unit (NICU) included intratracheal epinephrine spraying/irrigation, blood component therapy, and as necessary, surfactant supplement therapy was administered in cases that secondary RDS was diagnosed. High frequency oscillatory ventilation (HFOV) was utilized when hypoxia or respiratory acidosis persisted under conventional mechanical ventilation (CMV). We then described the clinical courses of severe pulmonary hemorrhage following our management.
A total of 18 (3.2%) out of 469 VLBW infants developed severe pulmonary hemorrhage. The mean gestational age was 27 weeks, the mean birth weight was 822 g, and the onset age was 2.5 days after birth. There was no severe pulmonary hemorrhage-associated mortality during this period with the exception of one case, in which an infant died after the parents refused to do further therapy. Sixteen (88.8%) neonates had RDS and 13 received surfactant therapy. Twelve (66.6%) cases developed secondary RDS following the onset of severe pulmonary hemorrhage, and four cases received surfactant supplement therapy. In the surfactant supplement group, alveolar-arterial oxygen difference (AaDO2) and oxygenation index (OI) during the 2-4 hours postpulmonary hemorrhage period showed statistically significant improvement, whereas the other group only showed a tendency toward improvement without reaching statistical significance when compared to the baseline data. Duration of high oxygen requirement [defined as fraction of inspired oxygen (FiO2) > 40%] was also less in the surfactant supplement group.
This data suggests that our current strategy is effective for treating severe pulmonary hemorrhage in VLBW infants. Surfactant therapy for severe pulmonary hemorrhage may also be beneficial for improving lung function and may shorten the duration of high oxygen requirement.
在接受表面活性剂治疗后，患有呼吸窘迫综合征（RDS）的早产儿发生严重肺出血是一种严重的并发症，死亡率很高。本研究旨在评估我们目前治疗严重肺出血新生儿的管理策略的疗效。
对 2006 年 1 月至 2011 年 8 月期间在新生儿重症监护病房（NICU）接受治疗的患有严重肺出血的极低出生体重（VLBW）婴儿进行了研究。在我们的 NICU 中，治疗严重肺出血包括气管内肾上腺素喷雾/冲洗、血液成分治疗以及在诊断出继发性 RDS 时必要时给予表面活性剂补充治疗。当常规机械通气（CMV）下存在缺氧或呼吸性酸中毒时，使用高频振荡通气（HFOV）。然后，我们描述了在我们的管理下严重肺出血的临床过程。
469 例 VLBW 婴儿中共有 18 例（3.2%）发生严重肺出血。平均胎龄为 27 周，平均出生体重为 822g，发病年龄为出生后 2.5 天。在此期间，除了一例因父母拒绝进一步治疗而死亡的患儿外，没有严重肺出血相关死亡。16 例（88.8%）新生儿患有 RDS，13 例接受了表面活性剂治疗。12 例（66.6%）患儿在发生严重肺出血后出现继发性 RDS，4 例接受了表面活性剂补充治疗。在表面活性剂补充组中，肺出血后 2-4 小时的肺泡-动脉氧差（AaDO2）和氧合指数（OI）均有统计学显著改善，而另一组仅表现出改善的趋势，但与基线数据相比无统计学意义。表面活性剂补充组的高氧需求持续时间（定义为吸入氧分数（FiO2）>40%）也较短。
本数据表明，我们目前的策略对治疗 VLBW 婴儿的严重肺出血有效。严重肺出血时的表面活性剂治疗也可能有益于改善肺功能，并可能缩短高氧需求的持续时间。
