Aetiology, Clinical Profile, Severity and Outcomes of Haemoptysis in Children: A Seven - Year Retrospective Study from a Tertiary Care Centre in Eastern India

Technical Summary: Aetiology, Clinical Profile, Severity, and Outcomes of Haemoptysis in Children

Problem Statement
Haemoptysis in children is an uncommon but clinically significant symptom that ranges from self-limiting respiratory infections to life-threatening emergencies. While data exists from high-income countries regarding causes like cystic fibrosis and vascular malformations, there is a scarcity of comprehensive data from low- and middle-income countries, particularly eastern India. Existing literature from this region is often descriptive, lacking detailed analysis of disease severity, bronchoscopy utility, intensive care requirements, and long-term recurrence. This study addresses the gap by characterizing the aetiological spectrum, clinical profile, and outcomes of paediatric haemoptysis in a tertiary care setting in eastern India.

Methodology
This was a retrospective analytical study conducted at the Institute of Child Health, Kolkata, a tertiary care centre serving urban and rural populations in eastern India. The study reviewed medical records of children aged 0–18 years presenting with documented haemoptysis between January 2018 and December 2024.

• Inclusion/Exclusion: 130 consecutive children with lower respiratory tract bleeding were included. Cases of epistaxis, haematemesis, iatrogenic bleeding, or incomplete records were excluded.
• Severity Classification: Haemoptysis was categorized as mild (<10 mL/day), moderate (10–50 mL/day), or massive (>50 mL/day or associated with clinical instability/respiratory distress).
• Diagnostic Workup: All patients underwent chest radiography. High-resolution computed tomography (HRCT) was performed in 57.7% of cases (those with recurrent symptoms, abnormal radiographs, or suspected structural disease). Bronchoscopy (flexible or rigid) was performed in 35.4% of cases for persistent, unexplained, or suspected foreign body cases.
• Follow-up: Recurrence was defined as a new episode after clinical resolution. Follow-up data was available for 110 patients (median duration 14 months).
• Statistical Analysis: Data were analyzed using SPSS v26.0. Continuous variables were presented as medians with interquartile ranges (IQR). Comparisons utilized Chi-square, Fisher's exact, or Mann–Whitney U tests.

Key Results

• Demographics: The cohort included 130 children (median age 8.5 years; 55.4% male). The most common presenting symptoms were cough (90%), fever (63%), and dyspnoea (35.4%).
• Aetiological Spectrum:
  • Respiratory Infections: The leading cause (40.0%, n=52).
  • Structural Pulmonary Disease: The second most common cause (24.6%, n=32), with post-infectious bronchiectasis being the predominant subtype (56.3% of structural cases).
  • Tuberculosis: 11.5% (n=15).
  • Foreign Body Aspiration: 9.2% (n=12), predominantly in younger children.
  • Cardiovascular Causes: 8.5% (n=11).
• Severity:
  • Mild: 47.7% (n=62).
  • Moderate: 34.6% (n=45).
  • Massive: 17.7% (n=23). Massive cases frequently presented with respiratory distress (60.9%) and required urgent intervention.
• Diagnostic Yield:
  • Chest radiographs were abnormal in 88.5% of cases.
  • HRCT identified bronchiectasis in 22 cases.
  • Bronchoscopy provided diagnostic information in 73.9% of the 46 children who underwent the procedure, with foreign bodies and endobronchial inflammation being common findings.
• Outcomes:
  • ICU Admission: 15.4% (n=20) required intensive care, primarily for massive haemoptysis and respiratory compromise.
  • Recurrence: Among 110 followed patients, recurrence occurred in 10.9% (n=12). Structural pulmonary disease was significantly associated with recurrence (25.0% vs. 5.1% in other groups, p=0.003).
  • Mortality: There were no in-hospital deaths or documented mortalities during the follow-up period.

Significance and Claims
The study claims to provide contemporary data on paediatric haemoptysis from an underrepresented region of India, highlighting specific local epidemiological patterns. Its primary contributions include:

1. Epidemiological Confirmation: It confirms that respiratory infections remain the leading cause of paediatric haemoptysis in eastern India, contrasting with high-income settings where structural and vascular anomalies are more prevalent.
2. Recurrence Drivers: The study identifies structural pulmonary disease, particularly bronchiectasis, as the principal determinant of recurrent haemoptysis, rather than the initial severity of the bleed.
3. Diagnostic Utility: It demonstrates the complementary roles of chest radiography, HRCT, and bronchoscopy, noting that bronchoscopy offers substantial diagnostic and therapeutic value (e.g., foreign body removal) in a significant proportion of cases.
4. Clinical Management: The findings underscore that while most episodes are mild, nearly one-fifth of children present with massive haemoptysis requiring intensive monitoring. The authors emphasize that morbidity in children is often driven by airway obstruction and hypoxaemia rather than exsanguination, necessitating prompt airway stabilization.

The paper concludes that early recognition of underlying structural lung disease and structured long-term follow-up are essential to mitigate the risk of recurrence in this population. The study acknowledges limitations regarding its retrospective design and single-centre nature but asserts that its inclusion of severity assessment, bronchoscopy outcomes, and recurrence data enhances its clinical relevance for managing paediatric haemoptysis in similar healthcare settings.