CARDIOPULMONARY SUPPORT FOR NEONATAL MASSIVE PULMONARY HEMORRHAGE (MPH)

MPH is a condition associated with very high mortality. In 1981 in our Unit 7/8 neonates with MPH died. MPH was defined as hypoxemia(PaO₂ 40 in FiO₂ .9)with fresh blood from the endotracheal tube & compatible chest X-ray features. Pathophysiologically MPH was considered as hemorrhagic pulmonary edema secondary to left ventricular dysfunction.¹ We therefore attempted to improve left ventricular function by optimising ventilation (muscle relaxants, sedation, positive end expiratory pressure 8-10 cm H₂0, high mean airway pressure 18-25) & improving myocardial contraction(Dopamine 5-10mcg/kg/min ± Isuprel 0.1 - 0.3mcg/kg/min). 5 patients have been successfully managed with this protocol. Also, ventricular function was assessed in 2/5 patients with M-mode echocardiogram & showed improvement in left ventricular ejection fraction & resolution of paradoxical septal motion.

We suggest that aggressive cardiopulmonary support including inotropes can alter the previous poor prognosis of MPH.

¹Cole: Pediatrics 512: 175-187, 1973.