Presented at the Neonatal Society 2002 Autumn Meeting.
Dorling J1, Eason J2, McClure R1, O’Neill K3
1 Rosie Maternity Hospital, Robinson Way, Cambridge, CB2 2QQ
2 Norfolk and Norwich University Hospital
3 Ipswich Hospital
Background: Pulmonary haemorrhage is a rare but serious cause of morbidity and mortality in very low birthweight infants. We analysed the aetiological factors and outcome at 2 years of age by comparing 24 cases with 24 matched controls.
Methods: Infants suffering pulmonary haemorrhage (PH group) in the Norfolk and Norwich Hospital during 1995 -1999 inclusive were identified from the East Anglian Very Low Birth Weight Database. This group was retrospectively compared with control infants who were born in the same year as their matched case, and were the closest match for gestational age and birth-weight. Infants with congenital malformations incompatible with life were excluded. Infants were compared for CRIB score, intraventricular haemorrhage, coagulation tests, patent ductus arteriosus and mortality. Neurodevelopmental examinations were also performed by an experienced, trained Staff Grade, using the Griffith’s Neurodevelopment scoring system at 2 years corrected gestational age.
Results: There were no differences between the groups for gender, mode of delivery, doses of antenatal steroids, Apgar scores, prolonged rupture of membranes, fever, antibiotics in labour and pre-eclampsia. There was no significant difference in CRIB scores; average 5.3 in PH group, 4.7 in controls (p = 0.48). Cerebral abnormality was more common in cases, being seen in 12 (50%) of cases and 7 (30%) of controls, but not significantly so (p=0.29). Mean APTT ratios were the same (2.8), and INR ratios similar (2.2 & 2.3). A PDA was no more prevalent in cases (33%) than in controls (46%). Cases were more likely to have metabolic acidosis (Base deficit > 7.0 mmol/L) 14 cases v 9 controls (p=0.005), but other individual aspects of the CRIB score were not different between the groups. Cases fared significantly worse at 2 years of age (see table).
Outcome at 2 years corrected gestational age (p=0.0008)
One case lost to follow up as moved country.
Conclusions: Our study has confirmed the poor outcome following pulmonary haemorrhage. Possible aetiological factors were examined, but except maximum base deficit in the first 12 hours, no statistically significant factors were found. This may be due to a lack of power in our study.