mohamad Posted August 23, 2012 Share Posted August 23, 2012 2 days ago we had a case of full term female suffering from sever perinatal hypoxia and 8 hours after birth she had pulmonary haemorrhage , and she died . I want to know what is the appropriate management of pulmonary haemorrhage , and what amount of blood components and fluids shoud i give to a neonate loosing large amount of blood in a short time , thank you . ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Mohamad Ismail Neonatology Resident Mansoura , Egypt . Link to comment Share on other sites More sharing options...
Stefan Johansson Posted August 25, 2012 Share Posted August 25, 2012 We would use HFOV as our mode of ventilation, and use a distending pressure that is relatively high without leading to over-distension. We would mostly use erytrocytes, aiming for an EVF around 40. Besides that we would use plasma to support volume and coagulation. Trombocytes would only be given if trc-penia develops, depending on the dynamics of the trc counts. Link to comment Share on other sites More sharing options...
JACK Posted August 25, 2012 Share Posted August 25, 2012 For pulmonary hemorrhage, we go for a high Peep strategy on conventional ventilator. Try to maintain hemodynamic stability. Try to see what is the cause (?DIC , ? PDA). Do NOT overtransfuse packed RBCs when you see Pulmonary Hemorrhage. We have very good experience with activated Factor 7 (Novoseven) in controlling pulmonary hemorrhage. Link to comment Share on other sites More sharing options...
mohamad Posted August 25, 2012 Author Share Posted August 25, 2012 What about drugs like tranexamic acid and ethamsylate ? Link to comment Share on other sites More sharing options...
Stefan Johansson Posted August 25, 2012 Share Posted August 25, 2012 We have very good experience with activated Factor 7 (Novoseven) in controlling pulmonary hemorrhage. Agree! Link to comment Share on other sites More sharing options...
vito62 Posted August 26, 2012 Share Posted August 26, 2012 We use Surfactant, HFOV, plasma and erytrocytes, but mortality remains very high, depending also of the inner cause (CID, PDA, sepsis ecc) Link to comment Share on other sites More sharing options...
Dinesh N Patel Posted August 27, 2012 Share Posted August 27, 2012 We use Conventional ventilation with high cpap, PRBc transfusion to keep hematocrit 40,Platelets if thrombocytopenia, FFP IF DIC PRESENT ,ET suction restricted to keep ET TUBE Open,. Avoid over transfusion, minimal handling, supportive. Care ,. Link to comment Share on other sites More sharing options...
mallikarjuna78 Posted September 8, 2012 Share Posted September 8, 2012 1. Not to keep on doing ET suction 2. Morphine/Fentanyl +/- Muscle relaxant 3. Hemodynamics Link to comment Share on other sites More sharing options...
mohamad Posted September 11, 2012 Author Share Posted September 11, 2012 Thank you for your kind answers . Link to comment Share on other sites More sharing options...
Alaaswaify Posted September 17, 2012 Share Posted September 17, 2012 we use either high peep on conventional ventilator(MAY REACH 8) or HFO . we try to look for the cause; we do PT and PTT, fbc , if PDA is open or if there is Fulminant sepsis . we correct thrombocytopenia by plat. transfusion , prolonged coagulation with FFP, and PRBCS FOR ANEMIA . WE MONITOR CENTRAL BP, SATUARTION AND GAS . ADEQUATE SEDATION OF THE BABY ( MORPHINE OR MIDAZOLAM). IF WE CAN'T MAINTAIN ADEQUATE OXYGENATION , SURFACTANT CAN BE GIVEN + ADEQUATE VENTILATOR MANGEMENT . SOMETIMES WE GIVE DIUREITCS (LASIX) . AVOID TOO MUCH SUCTIONING , FLUID MANAGEMENT ACCORDING TO SUSPECTED CAUSE , CORRECTION OF ACID BASE DISTURBANCES . Link to comment Share on other sites More sharing options...
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