Massive neonatal pulmonary bleeding: based on two cases

Abstract

Introduction: Pulmonary bleeding is a rare complication (0.8-1.2%) of preterm newborn. Its clinical onset is characterized by sudden cardiorespiratory deterioration, presence of blood in the trachea or endotracheal tube, decrease of hematocrit and radiological abnormalities. Its appearance has been long related with surfactant administration.
Clinical cases: Clinical case 1: 27 week old preterm newborn with mechanical ventilation since birth due to hyaline membrane disease. Surfactant (2 doses) was administered in the first 12 hours of life. On the third day of life, coinciding with improvement of respiratory symptoms, he presents episode of massive pulmonary bleeding with involvement of both pulmonary fields. Resolution is slow and he develops a picture of severe bronchopulmonary dysplasia later that required multiple treatments (oxygen therapy, water restriction, diuretics, bronchodilators and inhaled corticosteroids), requiring home oxygen therapy until 6 months of life.
Clinical case 2: 26 week old preterm newborn with mechanical ventilation from birth and hyaline membrane disease. Surfactant (2 doses) was administered in the first twelve hours of life. He evolved with multiorgan failure (renal failure, ventricular III-IV bleeding, hepatic failure with coagulopathy, hemodynamic instability that required inotropics). At 48 hours of life, bilateral pulmonary bleeding appeared, and he died 36 hours later, in spite of the therapeutic measures adopted.
Conclusions: Pulmonary bleeding presents high mortality (60%) in spite of early treatment. The survivors frequently develop chronic and severe pulmonary disorder that requires home oxygen in survivors for long time periods.