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Yang C, Ge Q, Huo X, Ge C. Cytomegalovirus pneumonia with intermittent pulmonary hemorrhage leading to asphyxia death: a case report and literature review. Virol J 2024; 21:131. [PMID: 38840200 PMCID: PMC11155117 DOI: 10.1186/s12985-024-02399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
Neonatal pulmonary hemorrhage is a late manifestation of various diseases. Premature delivery and low body weight are frequently observed as high-risk factors, characterized by acute onset, rapid progression, and high mortality rates. Pulmonary hemorrhage caused by cytomegalovirus infection in newborns with normal immune function is a rare occurrence. This case report focuses on a term neonate with normal birth weight who presented solely with nasal obstruction shortly after birth. However, 4 days after birth, the newborn experienced a sudden onset of blood gushing from both the mouth and nasal cavity. The patient was diagnosed with gastrointestinal bleeding, neonatal pneumonia and neonatal lung consolidation. And he was discharged after ten days of symptomatic treatment. However, upon returning home, the patient experienced a sudden onset of bleeding from the mouth and nose, leading to his untimely demise. Subsequent autopsy revealed the presence of pulmonary hemorrhage in newborn, which presented as interstitial pneumonia. The cause of pulmonary hemorrhage is cytomegalovirus infection. This case emphasizes the importance of pediatricians enhancing their skills in differentiating pulmonary hemorrhage, especially from cytomegalovirus pneumonia.
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Affiliation(s)
- Chenguang Yang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qi Ge
- Sanquan College of Xinxiang Medical University, Xinxiang, 453003, China
| | - Xiaochuan Huo
- Sanquan College of Xinxiang Medical University, Xinxiang, 453003, China
| | - Chang Ge
- Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China.
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Sun YP, Qin HB, Feng Y, Zou YS, Liu Y, Cheng R, Yang Y. Intubation at Birth Is Associated with Death after Pulmonary Hemorrhage in Very Low Birth Weight Infants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:621. [PMID: 38929201 PMCID: PMC11201528 DOI: 10.3390/children11060621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This retrospective cohort study was performed to clarify the association between intubation in the delivery room and the mortality after pulmonary hemorrhage in very low birth weight infants (VLBWIs) during hospitalization. METHODS The study participants were screened from the VLBWIs admitted to the neonatal intensive care unit (NICU) of the Children's Hospital Affiliated to Nanjing Medical University from 31 July 2019 to 31 July 2022. The newborns who ultimately were included were those infants who survived until pulmonary hemorrhage was diagnosed. These subjects were divided into the intubation-at-birth group (n = 29) and the non-intubation-at-birth group (n = 35), retrospectively. RESULTS Univariate analysis found that the intubation group had a higher mortality and shorter hospital stay than the non-intubation group (p < 0.05) (for mortality: 25/29 (86.21%) in intubation group versus 14/35 (40.00%) in non-intubation group). By multivariate analysis, the result further showed that intubation in the delivery room was related to shorter survival time and higher risk of death (adjusted hazard ratio: 2.341, 95% confidence interval: 1.094-5.009). CONCLUSIONS Intubation at birth suggested a higher mortality in the VLBWIs when pulmonary hemorrhage occurred in the NICU.
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Affiliation(s)
- Yong-Ping Sun
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Hou-Bing Qin
- Respiratory Department, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yun Feng
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yun-Su Zou
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yun Liu
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Rui Cheng
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yang Yang
- Department of Neonates, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
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Jung JK, Kim EY, Heo JS, Park KH, Choi BM. Analysis of perinatal risk factors for massive pulmonary hemorrhage in very low birth weight infant: A nationwide large cohort database. Early Hum Dev 2024; 191:105977. [PMID: 38460343 DOI: 10.1016/j.earlhumdev.2024.105977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To determine perinatal risk factors for Massive pulmonary hemorrhage (MPH) and MPH-caused mortality to guide clinicians in implementing preventive measures at the beginning of life for improving the survival of very low birth weight infant (VLBWIs). STUDY DESIGN A total of 13,826 VLBWIs born between 2013 and 2020 in the Korean Neonatal Network database were included. RESULTS MPH occurred in 870 (6.3 %) VLBWIs. Among infants with MPH, 162 (18.6 %) VLBWIs died due to MPH. In the multivariate logistic regression analysis, independent risk factors for MPH were identified as small for gestational age, multiple gestation, high CRIB-II score, use of surfactant, and symptomatic patent ductus arteriosus (sPDA) in VLBIWs. Independent risk factors for MPH-caused mortality were identified as multiple gestation in VLBWIs. Receiving a complete course of antenatal corticosteroids (ACS) was found to be a significant independent protective factor for MPH-caused mortality in VLBWIs. CONCLUSION Proactive managements for reducing unnecessary use of pulmonary surfactant and for decreasing the risk of sPDA at the beginning of life could be recommended as preventive strategies to reduce the risk of MPH in extremely preterm infants. ACS therapy is highly recommended for women with a high likelihood of giving birth preterm to reduce the risk of mortality caused by MPH.
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Affiliation(s)
- Jong Ki Jung
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Yeob Kim
- Medical Science Research Center, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hee Park
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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Wu ST, Lin CH, Lin YH, Hsu YC, Hsu CT, Lin MC. Maternal risk factors for preterm birth in Taiwan, a nationwide population-based cohort study. Pediatr Neonatol 2024; 65:38-47. [PMID: 37517971 DOI: 10.1016/j.pedneo.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/02/2023] [Accepted: 03/02/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The rate of preterm birth is increasing globally. It causes significant short-term and long-term health care burdens. A comprehensive recognition of the risk factors related to preterm births is important in the prevention of preterm birth. Our study is to investigate the incidence and maternal risk factors of preterm birth from a nationwide population-based perspective. METHODS This is a retrospective cohort study. All live births from 2004 to 2014 in Taiwan enrolled. The main data source was Taiwan's Birth Certificate Application (BCA) database. The BCA database was linked with the National Health Insurance Research Database (NHIRD) to establish any links between information on newborns and maternal underlying disease. RESULTS A total of 1,385,979 births were included in the analysis. The incidence of preterm birth increased gradually in Taiwan from 8.85% in 2004 to 10.73% in 2014. Maternal age, socioeconomic status, maternal allergy and autoimmune diseases, gynecological diseases, and pregnancy-related complications were significant risk factors for preterm birth. CONCLUSION The overall incidence of preterm births has gradually increased in Taiwan. Maternal age, socioeconomic status, certain underlying diseases, and pregnancy-related complications were risk factors for preterm birth.
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Affiliation(s)
- Sheng-Ting Wu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ya-Chi Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ting Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Food and Nutrition, Providence University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Gezmu AM, Tefera E, Mochankana K, Imran F, Joel D, Pelaelo I, Nakstad B. Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana. Front Pediatr 2023; 11:1171223. [PMID: 37388284 PMCID: PMC10306393 DOI: 10.3389/fped.2023.1171223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. Methods and materials A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. Result There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. Conclusion This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.
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Affiliation(s)
| | - Endale Tefera
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Kagiso Mochankana
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Fizzah Imran
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Irene Pelaelo
- Department of Paediatrics, Princess Marina Hospital Botswana MOH, Gaborone, Botswana
| | - Britt Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatric and Adolescent Medicine, Inst Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Inter-species cell detection - datasets on pulmonary hemosiderophages in equine, human and feline specimens. Sci Data 2022; 9:269. [PMID: 35660753 PMCID: PMC9166691 DOI: 10.1038/s41597-022-01389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/16/2022] [Indexed: 11/08/2022] Open
Abstract
Pulmonary hemorrhage (P-Hem) occurs among multiple species and can have various causes. Cytology of bronchoalveolar lavage fluid (BALF) using a 5-tier scoring system of alveolar macrophages based on their hemosiderin content is considered the most sensitive diagnostic method. We introduce a novel, fully annotated multi-species P-Hem dataset, which consists of 74 cytology whole slide images (WSIs) with equine, feline and human samples. To create this high-quality and high-quantity dataset, we developed an annotation pipeline combining human expertise with deep learning and data visualisation techniques. We applied a deep learning-based object detection approach trained on 17 expertly annotated equine WSIs, to the remaining 39 equine, 12 human and 7 feline WSIs. The resulting annotations were semi-automatically screened for errors on multiple types of specialised annotation maps and finally reviewed by a trained pathologist. Our dataset contains a total of 297,383 hemosiderophages classified into five grades. It is one of the largest publicly available WSIs datasets with respect to the number of annotations, the scanned area and the number of species covered.
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Kim H, Kim MS, Seo Y, Yum SK. Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age. J Matern Fetal Neonatal Med 2022; 35:9870-9877. [PMID: 35437100 DOI: 10.1080/14767058.2022.2065192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether advanced maternal age (35-39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. METHODS Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. RESULT Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. CONCLUSION AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.
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Affiliation(s)
- HyoYun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yumi Seo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Barnes ME, Feeney E, Duncan A, Jassim S, MacNamara H, O’Hara J, Refila B, Allen J, McCollum D, Meehan J, Mullaly R, O’Cathain N, Roche E, Molloy EJ. Pulmonary haemorrhage in neonates: Systematic review of management. Acta Paediatr 2022; 111:236-244. [PMID: 34582587 DOI: 10.1111/apa.16127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
AIM Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. METHODS A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes. RESULTS Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline. Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability. Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. CONCLUSION There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.
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Affiliation(s)
- Melissa E. Barnes
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Emily Feeney
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Andrew Duncan
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Samher Jassim
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Honora MacNamara
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Joseph O’Hara
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - Beshoy Refila
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
| | - John Allen
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Danielle McCollum
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Judith Meehan
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Rachel Mullaly
- Coombe Women and Infants University Hospital Dublin Ireland
| | - Niamh O’Cathain
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
| | - Edna Roche
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
| | - Eleanor J. Molloy
- Discipline of Paediatrics Trinity Collegethe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI)Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC) Dublin Ireland
- Children’s Hospital Ireland (CHI) at Tallaght Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
- Trinity Biomedical Sciences Institute (TTMI)TCD Dublin Ireland
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Lin Y, Zhao HF, Xue MH, Xie BJ, Zeng LC, Jiang X. Ultra-slim flexible bronchoscopy-guided topical hemostatic drugs administration for the management of life-threatening refractory pulmonary hemorrhage in a preterm infant: Case report. Front Pediatr 2022; 10:981006. [PMID: 36330371 PMCID: PMC9623275 DOI: 10.3389/fped.2022.981006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hemorrhage (PH) is a rare acute catastrophic event with high mortality among neonates, especially preterm infants. Primary treatments included pulmonary surfactant, high-frequency oscillatory ventilation, epinephrine, coagulopathy management, and intermittent positive pressure ventilation. However, there are still challenges in diagnosing and treating refractory or focal pulmonary hemorrhages. Ultra-slim bronchoscopy has been widely used in the field of critically ill children and is increasingly being done in neonates with critical respiratory disease in recent years. In this study, we report a case with refractory pulmonary hemorrhage in premature infants, which was finally diagnosed as localized hemorrhage in the upper left lobe and cured by ultra-slim bronchoscopy-guided topical hemostatic drug administration. Bronchoscopy is an optional, safe, and practicable technique for early diagnosis and direct injection therapy of neonatal PH in managing life-threatening PH.
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Affiliation(s)
- Yan Lin
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Hong-Fang Zhao
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Meng-Hua Xue
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Bing-Jie Xie
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ling-Chao Zeng
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xun Jiang
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University, Xi'an, China
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Wang L, Zhao LL, Xu JJ, Yu YH, Li ZL, Zhang FJ, Wen HM, Wu HH, Deng LP, Yang HY, Li L, Ding LL, Wang XK, Zhang CY, Wang H. Association between pulmonary hemorrhage and CPAP failure in very preterm infants. Front Pediatr 2022; 10:938431. [PMID: 36160772 PMCID: PMC9500376 DOI: 10.3389/fped.2022.938431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study. METHODS This was a multicenter case-control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24-32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses. RESULTS A total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48). CONCLUSIONS In this multicenter case-control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.
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Affiliation(s)
- Li Wang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li-Li Zhao
- Liaocheng People's Hospital, Liaocheng, China
| | - Jia-Ju Xu
- Yantai Yuhuangding Hospital, Yantai, China
| | - Yong-Hui Yu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Feng-Juan Zhang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hui-Min Wen
- Hebei PetroChina Central Hospital, Langfang, China
| | - Hai-Huan Wu
- Baogang Third Hospital of Hongci Group, Baotou, China
| | | | - Hui-Yu Yang
- Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Li Li
- Linyi People's Hospital, Linyi, China
| | - Lan-Lan Ding
- Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Xiao-Kang Wang
- Central Hospital of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Hui Wang
- Hebei PetroChina Central Hospital, Langfang, China
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11
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Covariation of changing patent ductus arteriosus management and preterm infant outcomes in Pediatrix neonatal intensive care units. J Perinatol 2021; 41:2526-2531. [PMID: 34354226 DOI: 10.1038/s41372-021-01170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/28/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test the hypothesis that NICU-specific preterm infant outcomes co-vary with changes in local patent ductus arteriosus (PDA) management. STUDY DESIGN This retrospective multicenter study examined NICU-specific aggregated data for infants born 400-1499 g (VLBW) in the Pediatrix Clinical Data Warehouse. For each NICU and each year 2006-2016 we calculated proportion of infants receiving cyclooxygenase inhibitor (COXI) and/or PDA ligation and determined NICU-specific changes in these therapies between consecutive years. We examined relationships between NICU-specific changes in COXI/ligation and concurrent changes in local adjusted in-hospital outcomes. RESULTS In 5678 observations of change at 259 NICUs summarizing 78,105 infants, between-year decreases in NICU-specific proportion treated with COXI/ligation were associated with concurrent increases in local mortality and decreases in BPD among infants 400-749 g, and with decreased pulmonary hemorrhage in larger infants. CONCLUSIONS NICU-specific adjusted mortality, BPD, and pulmonary hemorrhage rates co-vary with changes in local COXI/ligation rates in some VLBW infant subgroups.
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Bozkaya A, Yurttutan S, Özkars MY, Doğaner A. Respiratory problems in preterm infants with pulmonary hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7505-7510. [PMID: 34384331 DOI: 10.1080/14767058.2021.1951207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM Pulmonary hemorrhage is an important cause of morbidity and mortality in premature infants. There are few studies on pulmonary hemorrhage and associated morbidities observed in premature. The aim of this study was to investigate the possible relationship between pulmonary hemorrhage and respiratory problems in premature infants. MATERIAL AND METHOD Premature infants aged 25-32 weeks who were born between January 2014 and January 2018 in the neonatal intensive care unit were included to the study. Of these premature infants, 28 were patients diagnosed as pulmonary hemorrhage and 56 were control cases with the same demographic characteristics without pulmonary hemorrhage. From the medical records of infants; clinical course characteristics such as duration of ventilation, duration of oxygen supplementation, hospital stay were detailed. The data was analyzed statistically. RESULTS The duration of mechanical ventilation was significantly longer in the pulmonary bleeding group than in the control group (p: .001). There was a significant difference between the groups in terms of moderate and severe bronchopulmonary dysplasia (BPD) and the rate of BPD in the pulmonary hemorrhage group was higher than in the control group (17.2%-53.6%; p: .001). In addition, pulmonary hemorrhage group had significant patent ductus arteriosus (PDA) and preterm retinopathy (ROP) rate compared with control group. DISCUSSION This study implicated that, pulmonary hemorrhage is related with respiratory morbidities in preterm infants such as BPD and prolonged respiratory support. At the same time, the other morbidities such as ROP prolonged hospitalization are higher in infants with pulmonary hemorrhage. CONCLUSION In the follow-up of patients with pulmonary hemorrhage, defining respiratory problems and treatment and prophylaxis of comorbid conditions may be planned sooner.
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Affiliation(s)
- Aydın Bozkaya
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Sadık Yurttutan
- Department of Neonatology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Mehmet Yaşar Özkars
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Adem Doğaner
- Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
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Li J, Xia H, Ye L, Li X, Zhang Z. Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study. Transl Pediatr 2021; 10:1324-1332. [PMID: 34189090 PMCID: PMC8193000 DOI: 10.21037/tp-21-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage is a potentially fatal event especially for preterm infants, which can lead to serious complications and even death. Many risk factors have been associated with the development of massive pulmonary hemorrhage. However, there is still no effective strategy to prevent massive pulmonary hemorrhage. The purpose of this study is to explore prediction model and survival strategies for massive pulmonary hemorrhage in premature infants. METHODS In this retrospective study, we included all premature infants with birth weight <1,500 g who were hospitalized in our neonatal intensive care unit (NICU) between January 01 2010 and December 31 2019. RESULTS Of 599 preterm infants, 51 developed massive pulmonary hemorrhage. The logistic regression analysis showed that patent ductus arteriosus [odds ratio (OR) =11.4, 95% confidence interval (CI): 4.79-27.0, P<0.0001], coagulopathy (OR =6.56, 95% CI: 2.83-15.2, P<0.0001), and 10-minute Apgar Score (OR =0.52, 95% CI: 0.37-0.73, P=0.0001) were risk factors for massive pulmonary hemorrhage. Whether or not surfactant is used, the positive predictive value of combined patent ductus arteriosus and coagulopathy for predicting massive pulmonary hemorrhage was 68.9% and 70.4%, respectively. Of the 51 preterm infants with massive pulmonary hemorrhage, 25 died and 26 survived. The survivors group had higher positive end-expiratory pressure compared with the deceased group after the onset of massive pulmonary hemorrhage. After adjusting for potential risk factors, the multiple logistic regression analysis showed that higher positive end-expiratory pressure levels are closely related to survival. CONCLUSIONS Patent ductus arteriosus combined with coagulopathy has a high predictive value for massive pulmonary hemorrhage. Higher positive end-expiratory pressure levels may reduce mortality in massive pulmonary hemorrhage.
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Affiliation(s)
- Jing Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hejie Xia
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Ye
- Department of Neonatology, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
| | - Xiaoxia Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqun Zhang
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Abstract
The neonatal hemostatic system is strikingly different from that of adults. Among other differences, neonates exhibit hyporeactive platelets and decreased levels of coagulation factors, the latter translating into prolonged clotting times (PT and PTT). Since pre-term neonates have a high incidence of bleeding, particularly intraventricular hemorrhages, neonatologists frequently administer blood products (i.e., platelets and FFP) to non-bleeding neonates with low platelet counts or prolonged clotting times in an attempt to overcome these "deficiencies" and reduce bleeding risk. However, it has become increasingly clear that both the platelet hyporeactivity as well as the decreased coagulation factor levels are effectively counteracted by other factors in neonatal blood that promote hemostasis (i.e., high levels of vWF, high hematocrit and MCV, reduced levels of natural anticoagulants), resulting in a well-balanced neonatal hemostatic system, perhaps slightly tilted toward a prothrombotic phenotype. While life-saving in the presence of active major bleeding, the administration of platelets and/or FFP to non-bleeding neonates based on laboratory tests has not only failed to decrease bleeding, but has been associated with increased neonatal morbidity and mortality in the case of platelets. In this review, we will present a clinical overview of bleeding in neonates (incidence, sites, risk factors), followed by a description of the key developmental differences between neonates and adults in primary and secondary hemostasis. Next, we will review the clinical tests available for the evaluation of bleeding neonates and their limitations in the context of the developmentally unique neonatal hemostatic system, and will discuss current and emerging approaches to more accurately predict, evaluate and treat bleeding in neonates.
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Affiliation(s)
- Patricia Davenport
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
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15
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Marzahl C, Aubreville M, Bertram CA, Stayt J, Jasensky AK, Bartenschlager F, Fragoso-Garcia M, Barton AK, Elsemann S, Jabari S, Krauth J, Madhu P, Voigt J, Hill J, Klopfleisch R, Maier A. Deep Learning-Based Quantification of Pulmonary Hemosiderophages in Cytology Slides. Sci Rep 2020; 10:9795. [PMID: 32747665 PMCID: PMC7398908 DOI: 10.1038/s41598-020-65958-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 05/04/2020] [Indexed: 11/28/2022] Open
Abstract
Exercise-induced pulmonary hemorrhage (EIPH) is a common condition in sport horses with negative impact on performance. Cytology of bronchoalveolar lavage fluid by use of a scoring system is considered the most sensitive diagnostic method. Macrophages are classified depending on the degree of cytoplasmic hemosiderin content. The current gold standard is manual grading, which is however monotonous and time-consuming. We evaluated state-of-the-art deep learning-based methods for single cell macrophage classification and compared them against the performance of nine cytology experts and evaluated inter- and intra-observer variability. Additionally, we evaluated object detection methods on a novel data set of 17 completely annotated cytology whole slide images (WSI) containing 78,047 hemosiderophages. Our deep learning-based approach reached a concordance of 0.85, partially exceeding human expert concordance (0.68 to 0.86, mean of 0.73, SD of 0.04). Intra-observer variability was high (0.68 to 0.88) and inter-observer concordance was moderate (Fleiss' kappa = 0.67). Our object detection approach has a mean average precision of 0.66 over the five classes from the whole slide gigapixel image and a computation time of below two minutes. To mitigate the high inter- and intra-rater variability, we propose our automated object detection pipeline, enabling accurate, reproducible and quick EIPH scoring in WSI.
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Affiliation(s)
- Christian Marzahl
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany.
| | - Marc Aubreville
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christof A Bertram
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Jason Stayt
- VetPath Laboratory Services, Ascot, Western, Australia
| | | | | | | | - Ann K Barton
- Equine Clinic, Freie Universität Berlin, Berlin, Germany
| | - Svenja Elsemann
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Samir Jabari
- Institute of Neuropathology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Krauth
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Prathmesh Madhu
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörn Voigt
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Jenny Hill
- VetPath Laboratory Services, Ascot, Western, Australia
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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