Late sudden unexpected deaths in hospitalized infants with bronchopulmonary dysplasia
S. H. Abman, M. F. Burchell, M. S. Schaffer and A. A. Rosenberg
Department of Pediatrics, University of Colorado School of Medicine, Denver.
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 in-hospital 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 (greater than 50 mm Hg) and an elevated serum
bicarbonate level (greater than 30 mmol/L), but not hyponatremia,
hypochloremia (less than 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 beta-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.
