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Late Sudden Unexpected Deaths in Hospitalized Infants With Bronchopulmonary Dysplasia

Late Sudden Unexpected Deaths in Hospitalized Infants With Bronchopulmonary Dysplasia Abstract • To determine the relative contribution of sudden death as a cause of late inpatient mortality in newborns after prolonged mechanical ventilation, we reviewed the charts of 348 patients who received ventilation assistance and who were admitted to the neonatal intensive care unit during a 26-month period. The overall mortality rate for these patients was 25%, with 88% (77/88) of these deaths occurring within 30 days of birth. Eleven infants died after more than 60 days of mechanical ventilation. Seven of these late deaths were sudden, unexpected inhospital deaths. Sudden deaths occurred at a mean (uncorrected) age of 12 months (range, 4 to 27 months), during periods when infants appeared to be stable or clinically improving, were unrelated to recent respiratory exacerbations, and occurred despite prompt resuscitative efforts. Four infants still required mechanical ventilation, and 4 had tracheostomies at the time of death. All of the infants had chronic hypercarbia (50 mm Hg) and an elevated serum bicarbonate level (30 mmol/L), but not hyponatremia, hypochloremia (80 mmol/L), or alkalemia. Left and right ventricular hypertrophy, multiple drug therapy, recurrent cyanotic episodes, and frequent unexplained fevers were common. In comparison with 17 bronchopulmonary dysplasia survivors who required longer than 60 days of ventilation therapy, the late deaths group more frequently had left ventricular hypertrophy and received prolonged combination theophylline anhydrous and β-adrenergic agonist therapy. We report that sudden death can occur in infants with severe bronchopulmonary dysplasia despite in-hospital cardiopulmonary monitoring and the rapid institution of cardiopulmonary resuscitation, and is a significant cause of late mortality in infants who receive ventilation therapy for longer than 2 months. (AJDC. 1989;143:815-819) References 1. Northway WH, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline membrane disease . N Engl J Med . 1967;276:357-368.Crossref 2. O'Brodovich HM, Mellins RB. Bronchopulmonary dysplasia . Am Rev Respir Dis . 1985; 132:694-709. 3. Markestad T, Fitzhardinge PM. Growth and development in infants recovering from BPD . J Pediatr . 1981;98:597-602.Crossref 4. Abman SH, Accurso FJ, Koops BL. Experience with home oxygen in the management of infants with BPD . Clin Pediatr . 1984;23:471-476.Crossref 5. Morray JP, Fox WW, Kettrick RG, Downes JJ. Improvement in lung mechanics as a function of age in the infant with severe BPD . Pediatr Res . 1982;16:290-294.Crossref 6. Harrod JR, L'Heureux P, Wangensteen OD, Hunt CE. Long-term follow-up of severe respiratory distress syndrome treated with IPPB . J Pediatr . 1974;84:277-286.Crossref 7. Fouron JC, LeGuennec JC, Villemont D, Bard H, Perreault G, Davignon A. Value of echocardiography in assessing the outcome of BPD . Pediatrics . 1980;65:529-535. 8. Stocker JT. Pathologic features of long-standing 'healed' BPD: a study of 28 3-30-month-old infants . Hum Pathol . 1986;17:943-961.Crossref 9. Melnick HL, Pickoff AS, Ferrer PL, Peyser J, Bancalari E, Gelband H. Normal pulmonary vascular resistance and LVH in young infants with BPD . Pediatrics . 1980;66:589-596. 10. Werthammer J, Brown ER, Neff RK, Taeusch HW. Sudden infant death syndrome in infants with BPD . Pediatrics . 1982;69:301-304. 11. Perlman JM, Moore V, Siegel MJ, Dawson J. Is chloride depletion an important contributing cause of death in infants with BPD? Pediatrics . 1986;77:212-216. 12. Schreiner MS, Downes JJ, Kettrick RG, Ise C, Voit R. Chronic respiratory failure in infants with prolonged ventilator dependency . JAMA . 1987;258:3398-3404.Crossref 13. Kulkarni P, Hall RT, Rhodes PG, Sheehan MB. Postneonatal infant mortality in infants admitted to a neonatal intensive care unit . Pediatrics . 1978;62:178-183. 14. Turkel SB, Sims ME, Guttenberg ME. Postponed neonatal deaths in the premature infant . AJDC . 1986;140:576-579. 15. Sells CJ, Neff TE, Bennett FC, Robinson NM. Mortality in infants discharged from a neonatal intensive care unit . AJDC . 1983;137:44-47. 16. Gibson RL, Jackson JC, Twiggs GA, Redding GJ, Truog WE. Bronchopulmonary dysplasia: survival after prolonged mechanical ventilation . AJDC . 1988; 142:721-725. 17. deSweit M, Fayers P, Shinebourne EA. Systolic blood pressure in a population of infants in the first year of life: the Brompton study . Pediatrics . 1980;65:1028-1035. 18. Meyer RA. Pediatric Echocardiography . Philadelphia, Pa: Lea & Febiger; 1977:275,292-293. 19. Guntheroth WG. Pediatric Electrocardiography . Philadelphia, Pa: WB Saunders Co; 1965. 20. Koops BL, Lam C. Outcome in BPD: mortality risks and prognosis for growth, neurologic integrity, and developmental performance . In: Bancalari E, Stocker JT, eds. Bronchopulmonary Dysplasia . Washington, DC: Hemisphere Publishing Corp; 1988:403-415. 21. Koops BL, Abman SH, Accurso FJ. Outpatient management and follow-up of BPD . Clin Perinatol . 1984;11:101-122. 22. Beckerman RC. Unexpected death in infants monitored at home . AJDC . 1988;142:1033-1034. 23. Meny RG, Blackmon L, Fleischmann D, Gutberlet R, Naumburg E. Sudden infant death and home monitors . AJDC . 1988;142:1037-1040. 24. Abman SH, Warady BA, Lum GM, Koops BL. Systemic hypertension in infants with BPD . J Pediatr . 1984;104:928-931.Crossref 25. Jacobstein MD, Hirschfield SS, Winnie G, Doershuk C, Liebman J. Ventricular interdependence in severe cystic fibrosis . Chest . 1981;80:399-403.Crossref 26. McCord JM. Oxygen-derived free radicals in postischemia tissue injury . N Engl J Med . 1985;312:159-163.Crossref 27. deSa DJ. Myocardial changes in immature infants requiring prolonged ventilation . Arch Dis Child . 1977;52:138-147.Crossref 28. Larson DF, Womble JR, Copeland JG, et al. Epinephrine regulates conpensatory right and left ventricular hypertrophy . In: Calderera CM, Harris P, eds. Advances in Studies on Heart Metabolism . Bologna, Italy: CLUEB; 1982:513-518. 29. Roberts RJ. Pharmacologic approaches to the prevention and treatment of BPD . Respir Care . 1986;31:581-589. 30. Abman SH, Schaffer MS, Wiggins JW, Washington R, Manis-Johnson M, Wolfe RR. Pulmonary vascular extraction circulating norepinephrine in infants with BPD . Pediatr Pulmonol . 1987;3:386-391.Crossref 31. Simpson P. Stimulation of hypertrophy of cultured neonatal rat heart cells through an alpha-1 adrenergic receptor and induction of beating through an alpha-1 and beta-1 adrenergic interaction . Circ Res . 1985;56:884-894.Crossref 32. Schaffer MS, Zuberbuhler P, Wilson G, Rose V, Duncan WJ, Rowe RD. Catecholamine cardiomyopathy: an unusual presentation of pheochromocytoma . J Pediatr . 1981;99:276-279.Crossref 33. Garg M, Kurzner SI, Bautista D, Keens TG. Hypoxic arousal in infants with BPD . Pediatrics . 1988;82:59-63. 34. Brandenburg RO. Cardiomyopathies and their role in sudden death . J Am Coll Cardiol . 1985;5:185B-189B.Crossref 35. Maron BJ, Bonow RO, Cannon RO, Leon MB, Epstein SE. Hypertrophic cardiomyopathy: interrelations of clinical manifestations, pathophysiology and therapy . N Engl J Med . 1987; 316:780-789, 844-852.Crossref 36. Robin ED. Death from bronchial asthma . Chest . 1988;93:614-618.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Late Sudden Unexpected Deaths in Hospitalized Infants With Bronchopulmonary Dysplasia

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References (49)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1989.02150190065022
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Abstract

Abstract • To determine the relative contribution of sudden death as a cause of late inpatient mortality in newborns after prolonged mechanical ventilation, we reviewed the charts of 348 patients who received ventilation assistance and who were admitted to the neonatal intensive care unit during a 26-month period. The overall mortality rate for these patients was 25%, with 88% (77/88) of these deaths occurring within 30 days of birth. Eleven infants died after more than 60 days of mechanical ventilation. Seven of these late deaths were sudden, unexpected inhospital deaths. Sudden deaths occurred at a mean (uncorrected) age of 12 months (range, 4 to 27 months), during periods when infants appeared to be stable or clinically improving, were unrelated to recent respiratory exacerbations, and occurred despite prompt resuscitative efforts. Four infants still required mechanical ventilation, and 4 had tracheostomies at the time of death. All of the infants had chronic hypercarbia (50 mm Hg) and an elevated serum bicarbonate level (30 mmol/L), but not hyponatremia, hypochloremia (80 mmol/L), or alkalemia. Left and right ventricular hypertrophy, multiple drug therapy, recurrent cyanotic episodes, and frequent unexplained fevers were common. In comparison with 17 bronchopulmonary dysplasia survivors who required longer than 60 days of ventilation therapy, the late deaths group more frequently had left ventricular hypertrophy and received prolonged combination theophylline anhydrous and β-adrenergic agonist therapy. We report that sudden death can occur in infants with severe bronchopulmonary dysplasia despite in-hospital cardiopulmonary monitoring and the rapid institution of cardiopulmonary resuscitation, and is a significant cause of late mortality in infants who receive ventilation therapy for longer than 2 months. (AJDC. 1989;143:815-819) References 1. Northway WH, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline membrane disease . N Engl J Med . 1967;276:357-368.Crossref 2. O'Brodovich HM, Mellins RB. Bronchopulmonary dysplasia . Am Rev Respir Dis . 1985; 132:694-709. 3. Markestad T, Fitzhardinge PM. Growth and development in infants recovering from BPD . J Pediatr . 1981;98:597-602.Crossref 4. Abman SH, Accurso FJ, Koops BL. Experience with home oxygen in the management of infants with BPD . Clin Pediatr . 1984;23:471-476.Crossref 5. Morray JP, Fox WW, Kettrick RG, Downes JJ. Improvement in lung mechanics as a function of age in the infant with severe BPD . Pediatr Res . 1982;16:290-294.Crossref 6. Harrod JR, L'Heureux P, Wangensteen OD, Hunt CE. Long-term follow-up of severe respiratory distress syndrome treated with IPPB . J Pediatr . 1974;84:277-286.Crossref 7. Fouron JC, LeGuennec JC, Villemont D, Bard H, Perreault G, Davignon A. Value of echocardiography in assessing the outcome of BPD . Pediatrics . 1980;65:529-535. 8. Stocker JT. Pathologic features of long-standing 'healed' BPD: a study of 28 3-30-month-old infants . Hum Pathol . 1986;17:943-961.Crossref 9. Melnick HL, Pickoff AS, Ferrer PL, Peyser J, Bancalari E, Gelband H. Normal pulmonary vascular resistance and LVH in young infants with BPD . Pediatrics . 1980;66:589-596. 10. Werthammer J, Brown ER, Neff RK, Taeusch HW. Sudden infant death syndrome in infants with BPD . Pediatrics . 1982;69:301-304. 11. Perlman JM, Moore V, Siegel MJ, Dawson J. Is chloride depletion an important contributing cause of death in infants with BPD? Pediatrics . 1986;77:212-216. 12. Schreiner MS, Downes JJ, Kettrick RG, Ise C, Voit R. Chronic respiratory failure in infants with prolonged ventilator dependency . JAMA . 1987;258:3398-3404.Crossref 13. Kulkarni P, Hall RT, Rhodes PG, Sheehan MB. Postneonatal infant mortality in infants admitted to a neonatal intensive care unit . Pediatrics . 1978;62:178-183. 14. Turkel SB, Sims ME, Guttenberg ME. Postponed neonatal deaths in the premature infant . AJDC . 1986;140:576-579. 15. Sells CJ, Neff TE, Bennett FC, Robinson NM. Mortality in infants discharged from a neonatal intensive care unit . AJDC . 1983;137:44-47. 16. Gibson RL, Jackson JC, Twiggs GA, Redding GJ, Truog WE. Bronchopulmonary dysplasia: survival after prolonged mechanical ventilation . AJDC . 1988; 142:721-725. 17. deSweit M, Fayers P, Shinebourne EA. Systolic blood pressure in a population of infants in the first year of life: the Brompton study . Pediatrics . 1980;65:1028-1035. 18. Meyer RA. Pediatric Echocardiography . Philadelphia, Pa: Lea & Febiger; 1977:275,292-293. 19. Guntheroth WG. Pediatric Electrocardiography . Philadelphia, Pa: WB Saunders Co; 1965. 20. Koops BL, Lam C. Outcome in BPD: mortality risks and prognosis for growth, neurologic integrity, and developmental performance . In: Bancalari E, Stocker JT, eds. Bronchopulmonary Dysplasia . Washington, DC: Hemisphere Publishing Corp; 1988:403-415. 21. Koops BL, Abman SH, Accurso FJ. Outpatient management and follow-up of BPD . Clin Perinatol . 1984;11:101-122. 22. Beckerman RC. Unexpected death in infants monitored at home . AJDC . 1988;142:1033-1034. 23. Meny RG, Blackmon L, Fleischmann D, Gutberlet R, Naumburg E. Sudden infant death and home monitors . AJDC . 1988;142:1037-1040. 24. Abman SH, Warady BA, Lum GM, Koops BL. Systemic hypertension in infants with BPD . J Pediatr . 1984;104:928-931.Crossref 25. Jacobstein MD, Hirschfield SS, Winnie G, Doershuk C, Liebman J. Ventricular interdependence in severe cystic fibrosis . Chest . 1981;80:399-403.Crossref 26. McCord JM. Oxygen-derived free radicals in postischemia tissue injury . N Engl J Med . 1985;312:159-163.Crossref 27. deSa DJ. Myocardial changes in immature infants requiring prolonged ventilation . Arch Dis Child . 1977;52:138-147.Crossref 28. Larson DF, Womble JR, Copeland JG, et al. Epinephrine regulates conpensatory right and left ventricular hypertrophy . In: Calderera CM, Harris P, eds. Advances in Studies on Heart Metabolism . Bologna, Italy: CLUEB; 1982:513-518. 29. Roberts RJ. Pharmacologic approaches to the prevention and treatment of BPD . Respir Care . 1986;31:581-589. 30. Abman SH, Schaffer MS, Wiggins JW, Washington R, Manis-Johnson M, Wolfe RR. Pulmonary vascular extraction circulating norepinephrine in infants with BPD . Pediatr Pulmonol . 1987;3:386-391.Crossref 31. Simpson P. Stimulation of hypertrophy of cultured neonatal rat heart cells through an alpha-1 adrenergic receptor and induction of beating through an alpha-1 and beta-1 adrenergic interaction . Circ Res . 1985;56:884-894.Crossref 32. Schaffer MS, Zuberbuhler P, Wilson G, Rose V, Duncan WJ, Rowe RD. Catecholamine cardiomyopathy: an unusual presentation of pheochromocytoma . J Pediatr . 1981;99:276-279.Crossref 33. Garg M, Kurzner SI, Bautista D, Keens TG. Hypoxic arousal in infants with BPD . Pediatrics . 1988;82:59-63. 34. Brandenburg RO. Cardiomyopathies and their role in sudden death . J Am Coll Cardiol . 1985;5:185B-189B.Crossref 35. Maron BJ, Bonow RO, Cannon RO, Leon MB, Epstein SE. Hypertrophic cardiomyopathy: interrelations of clinical manifestations, pathophysiology and therapy . N Engl J Med . 1987; 316:780-789, 844-852.Crossref 36. Robin ED. Death from bronchial asthma . Chest . 1988;93:614-618.Crossref

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jul 1, 1989

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