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Clinical profile of 30 infants with acute pulmonary hemorrhage in Cleveland
Dorr G Dearborn1, Paul G Smith, Beverly B Dahms
1Pediatric Pulmonary Division, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106-5000, USA. dxd9@po.cwru.edu
Insights
Infants hospitalized with acute pulmonary hemorrhage often require intensive support. Environmental changes and glucocorticoids may reduce rebleeding and improve outcomes for these patients.
Area of Science:
- Pediatrics
- Pulmonology
- Neonatology
Background:
- Acute pulmonary hemorrhage is a serious condition in infants.
- Limited specific treatment options exist for this condition.
Observation:
- A study at Rainbow Babies and Children's Hospital observed 30 infants with acute pulmonary hemorrhage between 1993 and 2000.
- Most infants presented with severe symptoms, requiring intensive support including ventilator support and blood transfusions.
- Some infants experienced transitory hemoglobinuria, and five patients died.
Findings:
- Moving to a new home and avoiding environmental tobacco smoke were advised interventions.
- Subsequent rebleeding rates decreased significantly after environmental changes (from 5/7 to 1/21 infants).
- High-dose glucocorticoids showed potential value in reducing fatal hemorrhage, though low-grade alveolar hemorrhage persisted in some survivors.
Implications:
- Environmental modifications and glucocorticoid therapy may be beneficial in managing infant pulmonary hemorrhage.
- Further research is needed to establish specific treatment protocols.
- Long-term monitoring for persistent alveolar hemorrhage is recommended for affected infants.
Abstract:
Between 1993 and 2000, 30 infants were hospitalized with acute pulmonary hemorrhage at Rainbow Babies and Children's Hospital in Cleveland. Most infants presented with severe pulmonary symptoms requiring intensive support, but a few infants had less severe hemorrhage. Three quarters of the patients required ventilator support and blood transfusions. Eleven patients had transitory hemoglobinuria. Five patients died, but infants who survived did well. There are currently no specific treatment modalities, although we have advised moving to a different home and avoiding environmental tobacco smoke. Subsequently, rebleeding from the lower respiratory tract has decreased from 5 of 7 infants to 1 in 21. On the basis of decreased subsequent fatal hemorrhage, high dose glucocorticoids seem to be of some value. Several patients revealed continued low-grade alveolar hemorrhage for months after their initial bleed, even after removal from their original home environments.
