Does “POWS” pack a powerful enough punch to predict pulmonary hemorrhage in preterm infants?

Pulmonary hemorrhage (PH) in very low birth weight (VLBW) infants remains one of neonatology’s most destabilizing and devastating emergencies that is usually associated with a need for emergency resuscitation in the neonatal intensive care unit (NICU). 1 , 2 , 3 , 4 Yet it remains puzzlingly understudied and therefore, scientifically elusive. The clinical syndrome is recognizable (characterized by an acute respiratory decompensation with bloody secretions in the airway/endotracheal tube accompanied by diffuse radiographic changes), but its incidence, severity spectrum, and mechanistic subtypes are inconsistently defined. Consequently, the evidence for its prevention, early recognition or targeted therapy remains scant. 5 , 6 , 7 The accompanying paper by Lalos et al. 8 is therefore timely for its specific analytic findings while also spotlighting the broader vulnerability in neonatology of rare, heterogeneous, poorly phenotyped conditions, which are the hardest to study and yet where we need the most rigorous research.