Pediatrics |

Rescue High Frequency Ventilation in Pulmonary Hemorrhage in an Extremely Low Birth Weight Hypothermic Infant FREE TO VIEW

Marta Simon, PhD; Manuela Cucerea, PhD; Zsuzsanna Gall, MD; Monika Rusneac, MD; Luminita Zahiu, MD; Carmen Movileanu, MD; Raluca Marian, PhD; Laura Suciu, PhD
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University of Medicine and Pharmacy Targu -Mures, Targu-Mures, Romania

Chest. 2014;145(3_MeetingAbstracts):444A. doi:10.1378/chest.1823861
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SESSION TITLE: Pediatric Pulmonary Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Extremly low birth weight (ELBW) is one of the main reason for neonatal intensive care. ELBW infants are at risc for developing respiratory distress syndrome (RDS), hypothermia, intraventricular hemorrhage and symptomatic persistant ductus arteriosus. Improper care at birth may worsen the symptomatology and the outcome of these prematures.

CASE PRESENTATION: The authors present a case of an ELBW 26 weeker premature, with 660 g birthweight, who was born at home and had been transfered to our NICU after 10 hours of life with RDS, in severe hypothermia: 32grd Celsius. She initially was stable on BiPAP, but developed massive pulmonary hemorrhage in the first 12 hours after admittance and needed to be ventilated with high frequency requering high Mid Airway Pressure (MAP) and low frequency parameters in order to cease the hemorrhage. Further surfactant replacement was performed after 24 hours and HFOV lasted 15 days. Later outcome was favorable, without major complications like chronic lung disease or retinopathy of prematurity.

DISCUSSION: Hypothermia worsened the acid-base status, respiratory functions and left-to right shunting through PDA, leding to pulmonary hemorrhage. Increasing intrapulmonary pressure by lower frequency parameters of HFOV the shunt could be influenced in order to cease the hemorrhage. Despite higher MAP severe pulmonary fibrosis did not occur, due to a relatively constant pressure in the airways, that is lower than usually used parameters in conventional ventilation.

CONCLUSIONS: High frequency oscillatory ventilation should be the elective ventialtion mode in ELBW infants with RDS and/or pulmonary hemorrhage in order to get prompt respons and reduce major complications

Reference #1: Knobel R, Diane Holditch-Davis. Thermoregulation and Heat Loss Prevention After Birth and During Neonatal Intensive-Care Unit Stabilization of Extremely Low-Birthweight Infants. JOGNN May/June 2007. 36(3): 280-287.DOI: 10.1111/j.1552-6909.2007.00149.x

Reference #2: Cloherty, J., Eichenwald, E, Hansen AR, Stark, A.R, (Eds.). (2012). Manual of neonatal care (7th ed.). Philadelphia: Lippincott-Williams & Wilkins.

Reference #3: AlKharfy T M. High-Frequency Ventilation in the Management of Very-Low-Birth-Weight Infants with Pulmonary Hemorrhage. Amer J Perinatol 2004; 21(1): 19-26. DOI: 10.1055/s-2004-820505

DISCLOSURE: The following authors have nothing to disclose: Marta Simon, Manuela Cucerea, Zsuzsanna Gall, Monika Rusneac, Luminita Zahiu, Carmen Movileanu, Raluca Marian, Laura Suciu

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