Maternal haemolysis, elevated liver enzymes and low platelets syndrome: Specific problems in the newborn

Abstract

To evaluate the effects of maternal haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome on the fetus and neonate we retrospectively investigated the outcome of 87 pregnancies. All women showed thrombocytopenia, elevated liver enzymes and haemolysis. None of them died. Nine infants were stillborn (9.9%). Of the 82 liveborn infants, 66 were delivered by caesarean section. Median gestational age of the liveborn infants was 32.6 weeks, mean birth weight was 1576 g +/- 699 g (mean +/- SD). Of these infants, 44% were small for gestational age. Perinatal asphyxia rate was 21.6%. Nine infants died in the 1st week after birth. Complications during admission included neonatal respiratory disease (43.2%), hyperbilirubinaemia (44.7%), persistent ductus arteriosus (16.2%), thrombocytopenia (34%) and hypoglycaemia (16.2%). Artificial ventilation was necessary in 37 infants. Mean duration of admission was 51 days. HELLP syndrome is associated with poor perinatal outcome; the incidence of caesarean section is high and there is an increased risk for preterm birth and growth retardation. No specific neonatal pathology due to maternal HELLP syndrome was found.

Evaluation of Laboratory Disorders in Admitted Neonates in NICU Who Were Born to Preeclamptic Mothers

“…In addition, vulnerability of premature and low-birth-weight infants to hypoglycemia is a well-recognized problem in neonatal medicine. The present study revealed hypoglycemia in 33.3% of patients, similar to Dhananjaya et al study with a 40% incidence of hypoglycemia in preeclampsia/eclampsia (19) and comparable with Eiltink et al study (14).…”

“…Harms et al demonstrated leukopenia in 21% of the affected infants (9). Hyperbilirubinemia was the most common metabolic disorder with an incidence of 39.2% in the current study, comparable to the one by Eiltink et al (14) in which 44.7% of cases had jaundice. Hypertensive disorder is a maternal risk factor for development of hypoglycemia in infants.…”

“…Other studies showed variable incidences of thrombocytopenia as 33% by Harm et al (9), 34% by Eltink et al (14) and 36% by Bhat et al (15). Occurrence of thrombocytopenia was found to be associated with decreased birth weight and gestational age.…”

Pregnancy-Related Liver Disorders

“…acute renal failure, hepatic infarct, hepatic hematoma, hepatic rupture, disseminated intravascular coagulation, post-partum hemorrhage, pulmonary edema and rarely liver cell failure. [68][69][70][71][72] The mortality in patients with any of these severe complications is higher. There are usually no long term maternal complications.…”

“…Peri-natal complications and mortality is high and ranges from 20 to 30%. [69][70][71] Most of the perinatal complications, e.g. asphyxia, respiratory disease and others, seem to be related to prematurity rather than an inherited defect of metabolism.…”