Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study

Background To explore the clinical features, treatments and outcomes of diffuse alveolar hemorrhage (DAH) with onset in infancy with the aim of extending clinician’s awareness and improving the diagnostic and therapeutic accuracy for the disease. Methods The cases of DAH with onset in infancy, who had been hospitalized in the Department of Pediatrics at the First Affiliated Hospital of Guangxi Medical University from January 2012 and April 2025 were included. A retrospective study was conducted. Results 1. A total of 285 pediatric cases of DAH were included, in which 26 cases (9.1%) presented with onset in infancy. 2.Of the cases with onset in infancy, the median age at onset were 8.0 (4.8, 10.3) months. The median age at diagnosis were 11.0 (6.8, 21.8) months. The median duration from disease onset to diagnosis were 2.5 (1.0, 12.0) months. 3. At onset of the disease, the most common clinical manifestation was anemia which was found in 24 cases (92.3%) and the following clinical manifestations included cough in 14 cases (53.8%), hemoptysis in 9 cases (34.6%), dyspnea in 9 cases (34.6%), haematemesis in 2 cases (7.7%) and melena in 1 case (3.8%). Respiratory failure was found in 6 cases (23.12%). 4. Twenty three cases (88.5%) had received glucocorticoids treatment and 13 cases (50.0%) had received immunosuppressants treatment. 5. Assess of the clinical course were available in 21 cases, in which 18 cases (85.7%) presented a chronic and recurrent clinical course and 3 cases (14.3%) presented a transient clinical course. 5. By the end of April 2025, there were 20 cases with available follow-up, in which 1 case (5.0%) died and 19 cases (95.0%) survived. Of these 19 survived cases, 4 cases (21.1%) had decreased endurance activity. Follow-up chest CT revealed pulmonary fibrosis in 1 cases (3.8%). Conclusions DAH with onset in infancy was uncommon. It usually presented a chronic and recurrent clinical course. After treatments, death was less common, whereas pulmonary fibrosis or decreased endurance activity might develop.