Massive Pulmonary Haemorrhage Presumably Following Surfactant Administration in Very Preterm Neonates in Lagos, Nigeria: Report of Two Cases with Fatal Outcomes and Review of the Literature.

Pulmonary haemorrhage (PH) is bleeding from the lungs manifesting as bloodstained or pink frothy secretions from the trachea, often with acute clinical and respiratory deterioration. It is a rare but highly fatal complication of prematurity, often following surfactant replacement therapy (SRT), mechanical ventilation, coagulopathy and other risk factors. Despite having one of the highest burdens of global preterm births, there is paucity of reports on PH in Nigeria. Thus, we report two cases with fatal outcomes, aimed at raising awareness of PH among neonatal care providers in the context of increasing utilisation of SRT and advanced respiratory support in preterm care. Case 1 is a 29-week 5 day preterm who had surfactant therapy and continuous positive airway pressure but later had a massive PH resulting in death despite intubation, suctioning and resuscitation. Additional risk factors included sepsis, intraventricular haemorrhage and suspected coagulopathy. Case 2 is a 28-week preterm who was referred from a private hospital at the 18th hour of life and was mechanically ventilated and had SRT. He developed PH the following day and died despite transfusion and intratracheal adrenaline. Other risk factors were severe thrombocytopaenia and severe hyponatraemia. PH can be fatal. These cases highlight the need for early detection of PH before symptoms, especially in the context of SRT and MV, while also ensuring prompt and optimal management of sepsis, coagulopathy and electrolytes.