Pulmonary hemorrhage (PH) is infrequently seen in neonates but carries a very high mortality. Our understanding of this process is limited and this retrospective study was designed to describe the clinical correlates of this process. We identified all cases of PH in our tertiary care NICU from 7/1/88 to 6/30/95 and reviewed details of the episode. 2 controls/case matched for gestational age and birth weight were obtained from the same database. Of the 2980 admissions over the 7 year period, PH was diagnosed in 42 infants(incidence 1.4%). The mean age of occurrence was at 3.1 days (range 2 hours to 25 days). Factors associated with PH are shown. Statistical analysis by chi square test (*) or Mann-Whitney test (#) where appropriate. No statistical significance was seen between the two groups in regard to antenatal steroids, PIH, maternal chorio-amnionitis, cord pH, presentation, mode of delivery, 1 min. Apgar, race, sex, sepsis, PDA or IVH. All infants with PH were on mechanical ventilation prior to/during the episode. Pharmacologic support prior to/during the episode of PH included bicarbonate/THAM in 21 (50%), inotropic drugs in 15 (36%), fluid volume in 33 (79%), analgesics/sedatives in 11 (26%) and paralysis in 5 (12%). Treatment consisted of increasing mean airway pressure (MAP), nebulized epinephrine (Epi), nebulized 4% cocaine either singly or in combination. Outcome is shown below.Table We conclude that multiple gestation, a low Apgar at 5 minutes, RDS and surfactant use are associated with a significantly increased incidence of PH. Nebulized cocaine and Epi may be useful as adjuncts to increasing MAP in treating PH in neonates. Table

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