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 .

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Mohamad Ismail

Neonatology Resident

Mansoura , Egypt .

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.

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.

What about drugs like tranexamic acid and ethamsylate ?

We have very good experience with activated Factor 7 (Novoseven) in controlling pulmonary hemorrhage.

Agree!

We use Surfactant, HFOV, plasma and erytrocytes, but mortality remains very high, depending also of the inner cause (CID, PDA, sepsis ecc)

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 ,.

1. Not to keep on doing ET suction

2. Morphine/Fentanyl +/- Muscle relaxant

3. Hemodynamics

Thank you for your kind answers .

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 .

Hello, dear colleages! In case of severe asphyxia in term infant the main reason of pulmonary hemorrhage is pulmonary edema as a result of cardiac insufficiency due to myocardium ischemia, on my mind. Of course, we have to exclude congenital heart diseases, sepsis, etc. Our strategy is restriction of infusion, inotropic therapy (dopamine), lasix, dexamethasone (with uncertain efficiency), CMV with higher level of PEEP. We transfuse FFP only in case of development of DIC or severe hypocoagulation.

Hello, dear colleages! In case of severe asphyxia in term infant the main reason of pulmonary hemorrhage is pulmonary edema as a result of cardiac insufficiency due to myocardium ischemia, on my mind. Of course, we have to exclude congenital heart diseases, sepsis, etc. Our strategy is restriction of infusion, inotropic therapy (dopamine), lasix, dexamethasone (with uncertain efficiency), CMV with higher level of PEEP. We transfuse FFP only in case of development of DIC or severe hypocoagulation.

we manage patient with pulmonary hemmorrahge in our institute with high PEEP, KEEP hematocrit>40% , if any sign of DIC then we transfuse FFP

we manage patient with pulmonary hemmorrahge in our institute with high PEEP, KEEP hematocrit>40% , if any sign of DIC then we transfuse FFP