Introduction: Pulmonary hemorrhage (PH) is a life-threatening complication seen
in very sick newborns with high morbidity and mortality. There is little data on the
incidence, risk factors, and ultimate survival of newborns with pulmonary
hemorrhage in sub-Saharan countries, where the healthcare provision and facility
differ in many ways compared to high-income countries. Hence, this study aimed
to determine the incidence, identify the risk factors, and describe the outcome of
pulmonary hemorrhage in newborns in a low middle income country setting.
Methods and materials: A cohort study with prospective data collection was
conducted in a public, tertiary-level hospital in Botswana, the Princess Marina
Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020
to 31 December 2021 were included in the study. Data were collected using a
checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap).
The incidence rate of pulmonary hemorrhage was calculated as the number of
newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year
period. Group comparisons were made using X2 and Student’s t-tests.
Multivariate logistic regression was used to identify risk factors independently
associated with pulmonary hemorrhage.
Result: There were 1,350 newborns enrolled during the study period, of which 729
were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and
the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were
delivered in the same facility. The incidence of pulmonary hemorrhage was 54/
1,350 {4% [95% CI (3%–5.2%)]} among the newborns admitted to the unit. The
mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.
7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock,
disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal
encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood
transfusion as risk factors independently associated with pulmonary hemorrhage.
Conclusion: This cohort study identified a high incidence and mortality rate of
pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low
birth weight, anemia, blood transfusion, apnea of prematurity, neonatal
encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical
ventilation, were identified as independently associated risk factors for PH.
KEYWORDS
pulmonary hemorrhage, premature newborns, risk factors, very low birth weight,
extreme prematurity

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