Neonatal Death and Massive Pulmonary Haemorrhage in Jamaica.

Massive pulmonary haemorrhage in the newborn is a well-recognized but little understood condition, characterized by the presence in the alveoli and alveolar ducts, and sometimes in the interstitial spaces, of large numbers of erythrocytes. The distribution of haemorrhage may be patchy or confluent causing consolidation, as distinct from the petechial haemorrhages seen in infants dying after premature separation of the placenta, or the septal haemorrhages seen in stillbirths. The condition was probably first described by Browne (1922a) who found it in eight infants of a series of 153 neonatal deaths (1922b). He concluded that 'acute haemorrhagic pneumonia', as he called it, was a distinct entity, causing sudden death in full-term and premature infants, and caused by an overwhelming infection or an anaphylactic reaction. A study of 4,000 autopsies by Ahvenainen and Call (1952) revealed 67 cases of infants with massive pulmonary haemorrhage, 77% of whom were less than 15 days old. These cases included lungs showing any type of haemorrhage. The incidence of pulmonary haemorrhage reported by Sivanesan (1961) from Singapore was 8% of neonatal deaths and was the third most common pathological observation in the lungs. The frequent occurrence of massive pulmonary haemorrhage and the lack of knowledgeof its pathogenesis prompted an investigation of the cases occurring in the University of the West Indies in order to discover whether any further suggestions could be made to elucidate the aetiology. The results of this investigation and a discussion of the possible aetiological factors form the subject of this paper.