Pulmonary Hemorrhage Management Practices in Extremely Preterm Infants: A Global Survey

Background: Pulmonary hemorrhage (PHEM) can be life-threatening in extremely premature infants, with only supportive treatment available.Little is known regarding specific management strategies for PHEM because of the rarity of its occurrence and significant associated mortality.Materials and methods: A multi-institutional working group of physicians was created with the common goal of expanding knowledge about PHEM.We designed a 14-question survey around our experience and current controversies reported in the literature.The survey was circulated via neonatal listservs (MEDNAX neonatology forum, nicu99, Envision Physician Services, and the AAP Training and Early Career neonatologists' group) to capture the management strategies of various neonatologists practicing under different settings and resources.Smartphone Apps for the Global Newborn Society were also used to reach neonatal providers around the world.The data were collected in REDCap software, and statistical analysis was conducted using SPSS version 27.Results: There were 360 responses from 73 countries.Most neonatologists (79.2%) managed PHEM without unit-based guidelines.For the management of PHEM, there was a consensus on using endotracheal (ET) epinephrine, blood products and high-frequency oscillatory ventilation after acute PHEM.More participants responded using surfactant replacement after (55.6%) rather than during (33.1%) the management of PHEM.Post PHEM, most neonatologists obtain echocardiograms (66%) and consider treatment for patent ductus arteriosus (PDA) (65%), with the majority using acetaminophen (56.4%).Comparative analysis of practices in North America and other NICUs are also reported.Conclusions: Our study provides a global overview of experience, and opinion-based practices used in the management of PHEM and reflects on the lack of available algorithms.Creating high-quality, evidence-based guidelines is necessary to provide appropriate care and reduce heterogeneity in the management.