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Neonatal and infantile pulmonary hemorrhage: an autopsy study with clinical correlation
C M Coffin1, K Schechtman, F S Cole
1Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110.
Insights
Pulmonary hemorrhage (PH) is common in autopsied infants, particularly premature ones. However, PH rarely occurs as a primary condition, often being associated with other health issues.
Area of Science:
- Pediatric Pathology
- Neonatal Autopsy Studies
- Infant Lung Diseases
Background:
- Pulmonary hemorrhage (PH) is a significant finding in infant autopsies.
- Understanding the clinicopathologic features of PH is crucial for neonatal care.
- Previous studies have not fully elucidated the primary nature of PH in infants.
Purpose of the Study:
- To investigate the clinicopathologic characteristics of pulmonary hemorrhage in infants under one year of age.
- To determine the frequency and extent of PH in liveborn and stillborn infants.
- To identify clinical and pathological factors associated with PH in this population.
Main Methods:
- Retrospective analysis of autopsied infants (liveborn and stillborn) over a 12-month period.
- Evaluation of clinicopathologic features including pulmonary hemorrhage, pulmonary interstitial emphysema, hyaline membrane disease, and congenital malformations.
- Statistical analysis of 31 factors to identify associations with PH, considering estimated gestational age.
Main Results:
- Histologic evidence of PH was found in 74% of liveborn and 24% of stillborn infants.
- In liveborn infants with PH, the extent varied: <1/3 lung (42%), 1/3-2/3 lung (15%), >2/3 lung (42%).
- Hyaline membranes and extrapulmonary hemorrhage were significantly associated with PH; PH was more frequent in premature infants (24-39 weeks EGA) and associated with multiple conditions.
Conclusions:
- Autopsy-diagnosed pulmonary hemorrhage is frequent in infants, especially premature ones.
- Pulmonary hemorrhage as a primary condition in infants is exceedingly rare.
- PH in infants is typically secondary to other underlying pathologies.
Abstract:
We studied the clinicopathologic features of pulmonary hemorrhage in autopsied infants less than 1 year of age for a 12-month period. There were 70 liveborns (LB) and 24 stillborns (SB). The percentage of LB with pulmonary hemorrhage (PH), pulmonary interstitial emphysema (PIE), hyaline membrane disease (HMD), acute bronchopneumonia (ABP), congenital malformations (CM), and surgery (SUR) were analyzed according to weeks of estimated gestational age (EGA) and as an entire group. Overall, 74% of LB and 24% of SB had histologic evidence of PH. A semiquantitative evaluation of the extent of PH among the LB infants disclosed that hemorrhage involved less than one-third of the observed lung tissue in 42%, one-third to two-thirds of the lung was hemorrhagic in 15%, and the remaining 42% had more than two-thirds hemorrhagic lung parenchyma. A total of 31 clinical and pathologic factors were evaluated for their possible association or relationship to PH. Statistical analysis revealed that hyaline membranes and hemorrhage in other extrapulmonary sites were the only significant associations with PH. PH was more frequent in premature infants born between 24 and 39 weeks EGA and was always associated with multiple other conditions. Although the autopsy finding of hemorrhage in the lungs is relatively frequent in the population we studied, it appears that PH as a primary phenomenon in infants is extremely rare, if it occurs at all.