Can neonatal pulmonary hemorrhage be cured?

Neonatal pulmonary hemorrhage is very serious and poses great threat to newborns because it can easily lead to more serious complications. It can cause the child to have rapid breathing, respiratory distress, and induce more serious pneumonia. When this type of pulmonary hemorrhage occurs, the specific cause should be understood in a timely manner and the primary disease should be treated well. Let's take a look at this aspect.

Can neonatal pulmonary hemorrhage be cured?

'Pulmonary hemorrhage' is a serious and fatal complication. Most cases are complicated by neonatal respiratory distress syndrome, aspiration pneumonia, lung infection, pulmonary hypertension, etc.

This condition is a serious illness and can be life-threatening. It is recommended to first actively give endotracheal intubation and mechanical ventilation treatment. If conditions permit, high-frequency oscillatory ventilation treatment is recommended to control pulmonary hemorrhage. On this basis, actively treat the primary disease.

Treatment

1. Treatment of primary disease.

2. General treatment: Keep warm, maintain open airways, administer oxygen, correct acidosis, limit the infusion volume to 80 ml/(kg·d), and the drip rate to 3-4 ml/(kg·h).

3. Replenish blood volume: Children with anemia caused by pulmonary hemorrhage can be transfused with fresh blood, 10ml/kg each time, to maintain the hematocrit above 0.45.

4. Maintain normal heart function: Dopamine 5 to 10ug/(kg·min) can be used to maintain systolic blood pressure above 50mmHg (1mmHg=0.133 kPa). If heart failure occurs, fast-acting digitalis drugs can be used to control heart failure.

5. Mechanical ventilation: intermittent positive pressure ventilation (IPPV)/positive end-expiratory pressure (PEEP) can be used. For children at high risk of pulmonary hemorrhage, in order to use mechanical ventilation before pulmonary hemorrhage, the scoring criteria (Table 1) can be referred to. Those with a score of ≤2 can be observed; those with a score of 3 to 5 should use mechanical ventilation; and those with a score of ≥6 will not be effective even if mechanical ventilation is used. The ventilator parameters can be selected as follows: inspired oxygen concentration (FiO2) 0.6~0.8, PEEP 6~8cmH20 (1cmH2O = 0.098kPa), respiratory rate (RR) 35~45 times/min, maximum inspiratory peak pressure (PIP) 25~30cmH20, inspiration-expiration ratio (1/E) 1:1~1.5, gas flow (FL) 8~12L/min. In the early stage, blood gas should be measured every 30 to 60 minutes as a basis for adjusting ventilator parameters. Before pulmonary hemorrhage occurs, if poor lung compliance is found and the mean airway pressure (MAP) is as high as 15 cmH20, attention should be paid to the possibility of pulmonary hemorrhage. During the treatment of pulmonary hemorrhage, when PIP < 20cmH20 and MAP < 7cmH20, and normal blood gas can still be maintained, it often indicates that lung compliance is tending to normal and pulmonary bleeding has basically stopped. If cyanosis persists when PIP>40cmH20, it means severe pulmonary hemorrhage and the child often dies. The time to wean the ventilator must be considered comprehensively based on the condition of pulmonary hemorrhage and the impact of the primary disease on breathing.

6. Application of hemostatic drugs: After suctioning secretions in the airway, drip 0.2U of Renli Hemostatic plus 1ml of water for injection. After injection, use a resuscitation bag to pressurize and supply oxygen for 30s to promote the diffusion of the drug in the alveoli to promote platelet aggregation at the bleeding site. At the same time, inject 0.5U of Lipase plus 2ml of water for injection intravenously. 10 minutes after medication, the bloody fluid in the trachea will be reduced to varying degrees. After 20 minutes, inject again with the same method and dosage. Use the medicine for 2 to 3 times. Or use 1:10000 epinephrine 0.1-0.3ml/kg and drip it into the trachea. It can be repeated 2-3 times. Pay attention to monitor the heart rate.

7. Correction of coagulation mechanism disorders: According to the results of coagulation mechanism examination, if the platelet count is less than 80x109/L, in order to prevent disseminated intravascular coagulation, ultra-micro heparin 1U/(kg.h) or 6U/kg can be injected intravenously once every 6 hours to prevent microthrombosis. If neonatal disseminated intravascular coagulation has occurred, 31.2-62.5U (0.25-0.5 mg/kg) of heparin can be given by intravenous drip during the hypercoagulation period, once every 4-6 hours, or plasma, concentrated platelets, etc. can be transfused.