The Centers for Disease Control and Prevention (CDC) has developed criteria for the diagnosis of acute idiopathic pulmonary hemorrhage in infants.


Patient selection: infant born at >= 32 weeks gestation and currently <= 12 months of age


Criteria - all of the following:

(1) abrupt or sudden onset of overt bleeding with obvious evidence of blood in the airways

(1a) epistaxis, hemoptysis, or frank blood in larynx

(1b) > 20% of pulmonary macrophages hemosiderin-laden on broncho-alveolar lavage (BAL)

(1c) evidence of bleeding from the airway into the lung on lung biopsy or at post-mortem examination

(2) severe illness with acute respiratory distress or respiratory failure resulting in admission to the pediatric ICU, intubation and respiratory support

(3) diffuse unilateral or bilateral pulmonary infiltrates evident on chest X-ray, CT or other imaging studies within 48 hours of admission


Exclusion criteria:

(1) The hemorrhage is not caused by a medical procedure (laryngoscopy, intubation, etc.).

(2) The source of bleeding is not from the nose or oropharynx.

(3) The infant was previously healthy prior to the onset of hemorrhage. The infant did not have a neonatal problem that could cause pulmonary hemorrhage. The infant was discharged from the hospital after birth with an uneventful course.

(4) The infant has not previously required respiratory support with oxygen.

(5) There is no evidence of physical abuse.

(6) There is no evidence of a condition that would explain the bleeding (based on a complete evaluation including bronchoscopy).


Probable case:

(1) criterion 1 met

(2) criterion 2 or 3 met or expected to be positive


Suspected case:

(1) criterion 1c

(2) imaging studies not done or else negative (criterion 3)


Conditions that cause pulmonary hemorrhage and which need to be excluded before calling the bleeding idiopathic (Box 3, page 10):

(1) asphyxia

(2) bronchopulmonary dysplasia

(3) chronic lung disease

(4) congenital heart disease (mitral stenosis, cor triatriatum, left to right shunts, left-sided obstructive lesion, etc.)

(5) hemolytic disease

(6) hyaline membrane disease or respiratory distress syndrome

(7) instrumentation of the airways or intubation

(8) mechanical ventilation

(9) nasogastric feeding tube

(10) persistent pulmonary hypertension

(11) surfactant administration

(12) veno-occlusive disorders


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