Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study

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.