3. PULMONARY HEMORRHAGE IN THE NEONATAL PERIOD
Frequently fatal, predominantly affects premature infants and associated with severe systemic illness.
In intubated neonates, airway trauma from tube itself or
from suction catheters is often source of bleeding. Usually this is mild
and self limited, but cases of severe airway bleeding have been reported.
In a series of 12 cases of fatal massive pulmonary hemorrhage
in neonates left ventricular failure, secondary to congenital lesions, severe
RDS, sepsis or other causes, was the precipitating factor. Blood actually
represents severe pulmonary edema with extravasation of red cells into airspaces.
If hematocrit and protein content of blood within airspaces is compared
with that seen in peripheral blood, composition is different.
Kernicteurs, severe intracranial hemorrhage and hypothermia
have also been associated as leading to pulmonary hemorrhage. Mechanism
is felt to be secondary to severe hypoxia and increased left ventricular
end-diastolic pressure.
Bacterial pneumonia and sepsis with DIC can also trigger
massive pulmonary hemorrhage from direct tissue injury and leaking of blood
into alveolar spaces.
Hyperammonemia can induce intrapulmonary bleeding that
is felt to be related to direct toxicity on the pulmonary vascular endothelium.
Congenital malformations, including vascular lesions, will rarely present with pulmonary
hemorrhage in neonatal period.
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Pulmonary Hemorrhage in Infancy