Massive pulmonary haemorrhage as a cause of death in the neonate--a retrospective review.

Objectives: To examine massive pulmonary haemorrhage as an independent factor and as a co-factor in neonatal mortality by analysing the associated factors, with the purpose of identifying predisposing characteristics.

Design: A retrospective study reviewing 32 neonates who died of pulmonary haemorrhage. Data were extracted from the 2001 King Edward VIII Hospital (KEH) neonatal death records. Relevant obstetric and neonatal variables were used in the data analysis.

Setting: KEH, a tertiary care institute, provides secondary and tertiary services and functions as a referral centre for surrounding clinics and hospitals.

Results: Pulmonary haemorrhage occurred in 32 of 260 neonatal fatalities (12.3%). All cases of pulmonary haemorrhage fell into the low-birth-weight category (< 2,500 g), and 26 of the infants (81.25%) died during the early neonatal period. A gestational age of 28-32 weeks was recorded in 27 cases (87%) and 19 (60%) showed adequate growth for gestational age. Three infants had pulmonary haemorrhage as a primary cause of death. In the remaining 29, pulmonary haemorrhage was secondary to a variety of causes. Obstetric information revealed that 29 mothers (93.5%) experienced obstetric complications, viz. pre-eclampsia/eclampsia syndrome 21 (64.5%), abruptio placentae 5 (16.1%) and previous pregnancy losses 9 (29%). Seven babies were ventilated and 2 were diagnosed with patent ductus arteriosus.

Conclusion: The study revealed more well-grown babies than expected. Complications of pregnancy hypertension, abruptio placentae and previous pregnancy losses were more frequently associated with pulmonary haemorrhage in these neonates. The majority of babies suffering pulmonary haemorrhage were not associated with intensive care management.