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Neurogenic pulmonary oedema and intraventricular Haemorrhage in preterm neonates

Presented at the Neonatal Society 2007 Summer Meeting (programme).

Donovan EJ (introduced by Thwaites RJ)

Children’s Unit, St Mary’s Hospital, Plymouth PO3 6AD, UK

Purpose: The diagnosis and presentation of neurogenic pulmonary oedema in adults is compared with the clinical picture in babies with large intraventricular heamorrhages and haemorrhagic pulmonary oedema.

Neurogenic pulmonary oedema is a well described phenomenon presenting in adults following an acute rise in intracranial pressure associated with hypothalamic infarction or ischaemia (1,2). Sudden and massive catecholamine release is thought to cause increased pulmonary capillary volume leading to damage to the endothelium and disruption of the basement membrane of both the capillaries and the alveoli. Protein and fluid extravasation and bleeding present clinically as hemorrhagic pulmonary oedema.

In adults the onset is within minutes or hours of the insult and presents with dyspnoea, tachypnoea and mild haemoptysis, on chest examination crackles are noted. The respiratory symptoms generally resolve within 72 hours and the outcome dependent on the neurological injury.

Results: Four cases, gestations 25 - 28 weeks, weighing 600 - 1200g are presented illustrating the clinical picture in preterm infants. All demonstrate a degree of metabolic acidosis preceding haemorrhagic pulmonary oedema occurring at around 24 hours of age. Increasing ventilatory requirements, acute anaemia and the concurrent finding of a fresh and large Intraventricular haemorrhage were found in all four infants. The respiratory deterioration resolved within 12 hours but their outcomes were poor. Two infants died, one as a direct result of his IVH, one with complications from late NEC.

Conclusion: This paper concludes that despite this clinical scenario being well recognised in neonatal practice as described by these cases, that neurogenic pulmonary oedema has, hitherto, not been described in the neonatal literature.

1. Fontes RB, Aguiar PH, Zanetti MV, Andrade F, Mandel M, Teixeira MJ J Neurosurg Anesthesiol. 2003 Apr;15(2):144-50
2. S.J.Fletcher J.D Atkinson British Journal of Anaesthesia, 2003, Vol. 90, No. 2 238-240

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