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Notice to Readers: Availability of Case Definition for Acute
Idiopathic Pulmonary Hemorrhage in Infants
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 ina 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.
Abrupt or sudden onset of overt bleeding or frank evidence of blood in
the airway.
Severe presentation leading to acute respiratory distress or respiratory
failure, resulting in hospitalization in a pediatric intensive care unit with intubation
and mechanical ventilation.
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.
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