Prevalence, risk factors and outcome of neonatal Pulmonary hemorrhage in extremely preterm infants: A case control study

Objectives

To determine the prevalence of Pulmonary Hemorrhage (PH) in extremely preterm (EP) babies born before 28 weeks of gestation and evaluate the associated risk factors and outcomes.

Methods

This was a retrospective case-control study involving 45 EP babies born between 2015-2019 who met the criteria for PH. EP babies born before 28 weeks of gestation without PH served as controls. Demographics, baseline clinical variables prior to the occurrence of PH, and variables associated with the condition were assessed. Only babies who survived for at least 12 hours and those without congenital anomalies were included in the study. A logistic regression model was used to analyze the risk factors associated with PH.

Results

There were 638 EP babies born during this period, and 45 babies out of 638 were diagnosed with PH (prevalence rate 7%). Risk factors, including gestational age, birth weight, small for gestational age (SGA), Apgar score at 1 and 5 min, and surfactant given within 1 hour of delivery, were associated with the occurrence of PH by univariate analysis. A multivariant analysis showed only SGA, Apgar at 5 min, and surfactant administration within 1 hour were independent risk factors for PH. The mortality and intraventricular hemorrhage rate of the group with PH were significantly higher than those without PH. The rates of periventricular leukomalacia, moderate-to-severe bronchopulmonary dysplasia, and medically or surgically treated PDA were not significantly different between the PH and non-PH groups.

Conclusions

PH is more prevalent in EP babies and is associated with SGA, low Apgar score at 5 min, and surfactant.