Hemorrhagic Disease of the Newborn

Pathogenetic basis of the syndrome

The development of this life-threatening condition is based on a complex of morphological and functional disorders that form a vicious cycle. The following factors play a key role in the pathogenesis:

• Respiratory system immaturity. There is pronounced morphofunctional immaturity of the lung tissue combined with a critical surfactant deficiency.
• Vascular anomalies. The embryonic structure of the pulmonary vascular bed persists in the infant, impairing adequate gas exchange.
• Hypoxic damage. Antepartum or intrapartum hypoxia triggers a cascade of pathological reactions.
• Breakdown of adaptation. Severe systemic hemodynamics disorders and a profound imbalance in the blood coagulation system develop, which accounts for the hemorrhagic component.

Clinical presentation

The manifestation of the syndrome largely resembles classic hyaline membrane disease, but has its own specific, more severe features.

Respiratory system involvement The most striking visual sign is the appearance of foamy secretions from the newborn's mouth. This discharge often has a hemorrhagic character, turning pinkish-red. Pulmonary auscultation reveals an abundance of moist rales of various calibers against the background of generally weakened respiratory noise conduction.

Systemic manifestations and edema The pathology is not limited to the lungs. The child is diagnosed with severe heart failure and marked central nervous system (CNS) depression. Generalized edema develops via the following cascading mechanism:

1. Onset of severe hypoxia.
2. Addition of metabolic and respiratory acidosis.
3. Generalized increase in vascular wall permeability.
4. Escape of the liquid portion of the blood into tissues with the development of generalized edema syndrome.

Radiological signs

Chest X-ray is a strictly mandatory imaging study. Although the picture itself may be nonspecific for respiratory distress syndrome, it is critically important to rule out acute surgical pathology.

Key radiological features:

• Time of onset: the characteristic pattern manages to fully form within the first 6 hours after birth.
• Specific changes: there is a diffuse decrease in the transparency of the lung fields (especially pronounced in the lower lobes and lung apices). The "air bronchogram" sign and a general significant decrease in lung tissue aeration are visualized.
• Resolution dynamics: the regression of radiological signs takes a long time — from 1 to 4 weeks, which directly correlates with the initial severity of the patient's condition.

Recommended diagnostic panel

To accurately verify the severity of the condition and rule out concomitant pathologies, an expanded examination protocol is used, including instrumental, laboratory, and microbiological methods.

Class and exam questions

What else to study on this topic

• Mechanisms of hyaline membrane formation in newborns
• Features of the embryonic structure of the pulmonary vascular bed
• Principles of interpreting acid-base balance (ABB) and blood gases
• Technique and interpretation of neurosonography in premature infants
• Differential diagnosis of respiratory distress syndrome and thoracic surgical pathologies

Other topics in «Chapter 2. Neonatology»

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