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Extensive intraalveolar pulmonary hemorrhage in infants dying after surfactant therapy
1Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Insights
Exogenous surfactant therapy in premature infants may increase the risk of extensive intraalveolar pulmonary hemorrhage. While overall hemorrhage rates were similar, treated infants showed more severe intraalveolar bleeding, especially those surviving over 24 hours.
Area of Science:
- Neonatal Medicine
- Pediatric Pathology
- Respiratory Physiology
Background:
- Premature infants often require respiratory support due to underdeveloped lungs.
- Pulmonary hemorrhage is a serious complication in neonates.
- Exogenous surfactant therapy is a standard treatment for respiratory distress syndrome.
Purpose of the Study:
- To investigate the association between exogenous surfactant therapy and pulmonary hemorrhage in premature infants.
- To compare autopsy findings of pulmonary hemorrhage in surfactant-treated and untreated premature infants.
Main Methods:
- Retrospective autopsy analysis of 15 premature infants treated with exogenous surfactant and 29 untreated infants.
- Inclusion criteria: birth weight 501-1500 gm, survival 4 hours to 7 days, no congenital anomalies.
- Comparison of hemorrhage types and extents between the two groups.
Main Results:
- High rates of pulmonary hemorrhage were observed in both groups (80% treated vs. 83% untreated).
- Untreated infants had more interstitial hemorrhage and lung hematomas.
- Surfactant-treated infants showed significantly higher rates of extensive intraalveolar hemorrhage (53% vs. 14%, p < 0.05).
- Extensive intraalveolar hemorrhage was common in surfactant-treated infants surviving >24 hours (8/9).
Conclusions:
- Exogenous surfactant therapy is associated with an increased rate of extensive intraalveolar pulmonary hemorrhage in premature infants.
- This specific type of hemorrhage may be more prevalent in infants receiving surfactant, particularly those with longer survival times.
- Clinically significant pulmonary hemorrhage was frequently associated with extensive intraalveolar bleeding, regardless of surfactant treatment.
Abstract:
To assess the possible relationship between exogenous surfactant therapy and pulmonary hemorrhage in premature infants, we compared autopsy findings in 15 infants treated with exogenous surfactant and in 29 who died before the introduction of surfactant therapy. Infants who met the following criteria were included: birth weight 501 to 1500 gm, survival 4 hours to 7 days, and no congenital anomalies. Average birth weight, gestational age, and age at death were equivalent for the two groups. High rates of pulmonary hemorrhage were present in both groups (treated 80% vs untreated 83%). The untreated group had higher incidences of interstitial hemorrhage and lung hematomas and significantly more large interstitial hemorrhages: 31% untreated versus 0% treated (p < 0.05). The overall rate of intraalveolar hemorrhage was similar in the two groups, but surfactant-treated infants were more likely to have extensive intraalveolar hemorrhage: 53% versus 14% (p < 0.05). Most surfactant-treated infants who survived more than 24 hours had extensive intraalveolar hemorrhage (8/9). Patients who had extensive intraalveolar hemorrhage, with or without prior surfactant therapy, frequently had clinically significant pulmonary hemorrhage (7/12). These findings indicate that infants who die after surfactant therapy have higher rates of a specific type of pulmonary hemorrhage--extensive intraalveolar hemorrhage.