Recent short-term and long-term outcomes of massive pulmonary hemorrhage in extremely low birth weight infants: A nationwide cohort study

초록

Introduction: To evaluate the short- and long-term outcomes, particularly neurodevelopment, of extremely low birth weight (ELBW) infants with massive pulmonary hemorrhage, in the context of recent improvements in perinatal and neonatal intensive care. Study design: Data from the prospective registry of the Korean Neonatal Network of ELBW infants born in 69 hospitals across South Korea between 2014 and 2022 were retrospectively analyzed. Results: Seven hundred and eight (11.2 %) of 6344 ELBW infants were diagnosed with MPH and divided into survivors at discharge (n = 253, 35.7 %) and in-hospital deaths (n = 455, 64.3 %). The annual incidence of MPH significantly declined from 13.9 % in 2014 to 7.7 % in 2022, and was accompanied by a similar decrease in inhospital mortality. Surviving infants who experienced MPH had higher rates of in-hospital morbidities. They also showed more adverse neurodevelopmental outcomes than those without MPH. After multivariable adjustment, the risks of cerebral palsy (OR 2.136; 95 % CI 1.253-3.638) and moderate developmental delay on BSID-II/III (OR 2.088; 95 % CI 1.279-3.409) remained significantly higher in MPH survivors. Conclusion: The incidence and in-hospital deaths of massive pulmonary hemorrhage in ELBW infants have decreased in recent years. However, improved survival may be accompanied by increased in-hospital morbidity and adverse neurodevelopmental outcomes, underscoring the need for ongoing monitoring and strategies to mitigate short- and long-term complications in this high-risk population.

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