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Pulmonary hemorrhage in neonatal respiratory distress syndrome: Radiographic evolution, course, complications and

M Lee1, K Wu1, A Yu1

  • 1Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA.

Journal of Neonatal-Perinatal Medicine
|July 1, 2019
PubMed

Insights

Pulmonary hemorrhage in premature infants often leads to chronic lung disease, but chest X-rays show improving interstitial patterns over time as oxygen needs decrease.

Area of Science:

  • Neonatal Medicine
  • Pediatric Radiology
  • Respiratory Physiology

Background:

  • Pulmonary hemorrhage (PH) is a known complication in premature infants treated for respiratory distress syndrome (RDS).
  • Frequent chest radiographs (CXRs) in these infants allow for detailed radiographic-clinical correlation.

Purpose of the Study:

  • To document the natural progression of CXR findings in infants with PH secondary to RDS.
  • To correlate specific radiographic patterns with the requirement for supplemental oxygen.

Main Methods:

  • Retrospective review of clinical data including gestational age, birth weight, and intraventricular hemorrhage (IVH).
  • Analysis of CXRs at four time points: during PH, 28 days postnatal, 36 weeks corrected age, and at the farthest clinical follow-up.
  • Correlation of radiographic findings with supplemental oxygen needs.

Main Results:

  • Fifty percent of infants with PH showed a 'whiteout' pattern on initial CXR; 50% had associated IVH.
  • At 28 days, fine-interstitial (FI) markings were prevalent (93%).
  • By farthest follow-up, most infants showed interstitial changes (FI, coarse-interstitial, or peri-bronchial cuffing) and hyperinflation, with decreasing home oxygen requirements over time.

Conclusions:

  • Survivors of PH in premature infants may develop chronic lung disease of prematurity.
  • CXR findings evolve from acute patterns to interstitial changes that gradually resolve.
  • The need for supplemental oxygen decreases as infants mature and outgrow their respiratory support requirements.
Abstract

Keywords:
Pulmonary hemorrhagechronic lung disease of prematurityrespiratory distress syndrome

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