During 1990-1994 58 VLBW infants (Bwt 900 g, gest age 26.5±2 wk) developed pulmonary hemorrhage (PH) in our NICU (6% of VLBW admissions), of whom 29 (50%) survived.

To describe the correlates of death and outcomes among survivors, we compared the neonatal course and 20-month neurodevelopmental outcomes of infants with PH to VLBW controls matched by Bwt, sex, race and need for assisted ventilation for RDS. Despite similar severity of lung disease more infants with PH received surfactant (91% vs 69%, p=.005).

PH occurred at a median of 40 hrs (range 7-511 hrs). Infants who died had a significantly lower Bwt and gest age, higher oxygenation index (OI), and received more surfactant. Survivors compared to controls, did not differ significantly in rates of oxygen dependence at 36 wks (52% vs 38%), grade 3-4 IV bleed (28% vs 17%), NEC (3% vs 7%), or septicemia (31% vs 41%), but tended to have more seizures (24% vs 3%, p=0.052), PVL (17% vs 0%, p=0.06) and PDA(79% vs 55%, p=0.09). At 20 months corrected age there were no significant differences in respiratory or neurodevelopmental outcomes [total days oxygen dependence median 56 days (range 10-634) for PH vs median 31 days (range 4-680) for controls (p=0.15); cerebral palsy 16% vs 14%; subnormal Bayley Mental Developmental Index (<70) 59% vs 43%]. Table

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Thus although mortality is high, pulmonary hemorrhage does not significantly increase the risk of later pulmonary or neurodevelopmental handicap in surviving VLBW children.