Pediatrics and Neonatology (2014) xx, 1e2
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LETTER TO THE EDITOR
Pulmonary Hemorrhage in Very-Low-BirthWeight Infants To the Editor 1
The study by Yen et al is very interesting and possibly clinically useful. According to their study, between 2006 and 2011, 18 (3.2%) of 469 very-low-birth-weight (VLBW) infants developed severe pulmonary hemorrhage (PH). The mean gestational age (GA) was 27 weeks, the mean birth weight (BW) was 822 g, and the onset age was 2.5 days after birth. Among these 18 infants, 16 (88.9%) had respiratory distress syndrome (RDS) and 13 received surfactant therapy; eight patients (44.4%) had patent ductus arteriosus (PDA), which was confirmed by echocardiography. All 13 patients who received surfactant therapy developed severe PH within 72 hours after surfactant treatment. This is about the timing that overlapped with the emergence of hemodynamically significant PDA. The paper, however, did not report how many infants among these 13 patients developed hemodynamically significant PDA and whether or not they received any treatment for it. When did the other five patients (including 2 without RDS and 3 with RDS but who did not receive surfactant therapy) develop severe PH? Did they also have hemodynamically significant PDA? At present, there is no consensus on the treatment for severe PH in VLBW infants. Treatment for severe PH in their neonatal intensive care unit included not only intratracheal epinephrine spraying/irrigation but also blood component therapy for coagulopathy or thrombocytopenia. The paper also did not report the number of infants who developed severe PH and presented with bleeding problems. The precise etiology of PH in VLBW infants remains unclear. Lin et al2 reported that the hemodynamically significant PDA had an odds ratio of 8.5 (p < 0.006) and RDS with surfactant therapy had an odds ratio of 7.4 (p < 0.006) for
severe PH in a cohort of 1997e1998, with an incidence of massive PH of 5.9% (20/340), mean GA of 26.9 weeks, and mean BW of 909 g. Chen et al3 reported that there was no difference in the incidence of PDA between PH infants and non-PH infants, but did show a significant difference in the use of surfactant therapy (p < 0.001) in 399 VLBW infants admitted to Kaohsiung Veterans General Hospital between 2000 and 2010, with a 4% incidence of massive PH (16/399), mean GA of 26.1 weeks, and mean BW of 865 g. These data, as compared with that of Yen et al,1 imply that the incidence of severe PH seems to have been reducing in the recent 5 years in Taiwan. As the authors described, the risk factors for PH were prematurity, intrauterine growth restriction, respiratory problems, PDA, bleeding problems, ventilator usage, and surfactant treatment.1 Without an answer to these questions, it is difficult to realize the causes of severe PH and the exact role of their current treatment including intratracheal epinephrine therapy, high-frequency oscillation ventilator, or surfactant supplement therapy in VLBW infants with severe PH.
Conflicts of interest All contributing authors declare no conflicts of interest.
References 1. Yen TA, Wang CC, Hsieh WS, Chou HC, Chen CY, Tsao PN. Shortterm outcome of pulmonary hemorrhage in very-low-birthweight preterm infants. Pediatr Neonatol 2013;54:330e4. 2. Lin TW, Su BH, Lin HC, Hu PS, Peng CT, Tsai CH, et al. Risk factors of pulmonary hemorrhage in very-low-birth-weight infants: a two-year retrospective study. Acta Paediatr Taiwan 2000;41:255e8.
http://dx.doi.org/10.1016/j.pedneo.2014.01.005 1875-9572/Copyright ª 2014, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved . Please cite this article in press as: Su B-H, et al., Pulmonary Hemorrhage in Very-Low-Birth-Weight Infants, Pediatrics and Neonatology (2014), http://dx.doi.org/10.1016/j.pedneo.2014.01.005
Letter to the Editor
3. Chen YY, Wang HP, Lin SM, Chang JT, Hsieh KS, Huang FK, et al. Pulmonary hemorrhage in very low-birthweight infants: risk factors and management. Pediatr Int 2012;54:743e7.
Bai-Horng Su* Hsiang-Yu Lin Fu-Kuei Huang Ming-Luen Tsai Department of Neonatology, China Medical University Children’s Hospital, Taichung, Taiwan
Department of Pediatrics, School of Medicine, China Medical University, Taichung, Taiwan *Corresponding author. Department of Neonatology, China Medical University Children’s Hospital, Number 2, Yuh-Der Road, Taichung 404, Taiwan. E-mail address: [email protected]
(B.-H. Su) Nov 27, 2013
Please cite this article in press as: Su B-H, et al., Pulmonary Hemorrhage in Very-Low-Birth-Weight Infants, Pediatrics and Neonatology (2014), http://dx.doi.org/10.1016/j.pedneo.2014.01.005