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From the Centers for Disease Control and Prevention
August 15, 2001

Pulmonary Hemorrhage in Infants

JAMA. 2001;286(7):786. doi:10.1001/jama.286.7.786-JWR0815-5-1

MMWR. 2001;50:494-5

In response to CDC recommendations published in March 2000,1 CDC has established procedures for the surveillance of acute idiopathic pulmonary hemorrhage in infants (AIPHI) and for conducting investigations and special studies. As part of these activities, CDC convened three meetings to (1) establish a case definition and classification scheme for public health surveillance of AIPHI, (2) recommend a standard home environment investigation protocol, and (3) outline a plan for surveillance and investigation of AIPHI. An AIPHI case definition for public health surveillance would facilitate case finding to document the burden of the condition and studies to identify possible etiologic agents or risk factors. Following are the recommended clinical description and case definition.

Proposed Clinical Description of AIPHI

Cases of AIPHI are characterized by the sudden onset of pulmonary hemorrhage in a previously healthy infant. Evidence of pulmonary hemorrhage includes hemoptysis, and finding blood in the nose or airway with no evidence of upper respiratory or gastrointestinal bleeding. Patients present with acute, severe respiratory distress or failure requiring mechanical ventilation and often demonstrate bilateral infiltrates on chest radiograph.

Proposed Criteria for a Clinically Confirmed Case of AIPHI

A clinically confirmed case is an illness in a previously healthy infant aged <1 year with a gestational age of ≥32 weeks with no history of neonatal medical problems that could cause pulmonary hemorrhage and who meets criteria A, B, and C.

A. Abrupt or sudden onset of overt bleeding or frank evidence of blood in the airway.

B. Severe presentation leading to acute respiratory distress or respiratory failure, resulting in hospitalization in a pediatric intensive care unit with intubation and mechanical ventilation.

C. Diffuse, bilateral pulmonary infiltrates on chest radiograph or computerized tomography of the chest.

Additional information about the report and copies of the case definition are available from CDC's Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Mailstop E-17, 1600 Clifton Rd, N.E., Atlanta, GA 30333; telephone (404) 639-2520. The full proposed case definition and classification scheme "Case Definition for Acute Idiopathic Pulmonary Hemorrhage in Infants" is available at http://www.cdc.gov/nceh/asthma/acute/AIPHIcasedef.htm.

CDC, Update: pulmonary hemorrhage/hemosiderosis among infants—Cleveland, Ohio, 1993-1996. MMWR. 2000;49180- 4