Evaluation of Patients With Pulmonary Hemorrhage in a Tertiary Neonatal Intensive Care Unit in Türkiye

Pulmonary hemorrhage (PHem) is a severe and often fatal condition in neonates, particularly affecting preterm and very low birth weight infants. It is associated with significant morbidity and mortality, yet distinctions between early- and late-onset PHem and their respective risk factors remain unclear. This study aimed to evaluate clinical characteristics, risk factors, management strategies, and outcomes of neonates with PHem, with a focus on early versus late onset.

In this retrospective cross-sectional study, medical records of neonates diagnosed with PHem in a tertiary NICU between January 2014 and December 2020 were analyzed. Early PHem was defined as onset within the first 7 days of life, and late PHem as onset thereafter. Collected data included antenatal, perinatal, and postnatal variables, surfactant and PDA management, and clinical outcomes. Statistical analyses included univariate and multivariate logistic regression to identify risk factors for early PHem and mortality.

A total of 80 neonates with PHem were included (mean gestational age 27.7 ± 3.6 weeks; mean birth weight 1092 ± 587 g). Early PHem accounted for 83.7% (n = 67) and late PHem for 16.3% (n = 13) of cases. Infants with early PHem had significantly higher mean airway pressure (MAP) at 12 h (p = 0.044) and a greater need for post-PHem surfactant therapy (p = 0.044). Conversely, late PHem was associated with higher rates of sepsis (p = 0.009), coagulopathy (p = 0.019), and hemodynamically significant PDA (92.3% vs. 47.8%, p = 0.008). Duration of mechanical ventilation (p < 0.001) and oxygen therapy (p = 0.002) were longer in the late PHem group. Overall mortality was 82.5%, with no statistically significant difference between early and late PHem (80.6% vs. 92.3%, p = 0.446).

PHem remains a significant cause of neonatal morbidity and mortality. Early and late PHem represent distinct clinical entities with different risk profiles, their management and long-term outcomes are similar. Despite these differences, mortality remains high in both groups. Identification of key risk factors, especially delivery room resuscitation, may guide preventive strategies and optimize neonatal care.