New Therapeutic Aspects in Nonimmune Hydrops fetalis Based on Four Hundred and Two Prenatally Diagnosed Cases

Prognostic factors for survival of 62 fetuses and neonates with nonimmune hydrops fetalis (NIHF) were studied retrospectively. Twenty-eight infants survived ≥28 days which is 45% for all fetuses and newborns diagnosed with NIHF and 61% for liveborns with unresolved NIHF. Univariate analysis identified that mortality was associated with the presence of ≥2 serous cavity effusions and a need for chest compressions at birth. Multivariate logistic regression analysis confirmed that the presence of ≥2 serous cavity effusions was significantly associated with mortality from NIHF <28 days after birth [OR = 48.2 (CI 3.6, 662.9) (p < 0.004)]. We conclude that, compared to published cases from the 1970s and early 1980s, survival of liveborns with NIHF seems improved. The decrease in stillbirths is more notable. The severity of hydrops at birth is the key determinant for survival.

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“…This is consistent with the data of Hansmann et al [18] who reported a 4% survival in cases diagnosed before 24 weeks of gestation.…”

Section: Discussionsupporting

confidence: 93%

“…The poorest outcome in the present cohort is for idiopathic cases, 21% in this series, which is consistent with the results of other reports [12,18]. It is probable that, despite detailed fetal and neonatal investigations, specific diagnoses may have been missed, since in other studies only 8% [1] to 12% [15] were labeled as idiopathic.…”

Section: Discussionsupporting

confidence: 90%

Nonimmune Hydrops fetalis: Fetal and Neonatal Outcome during 1983–1992

Wafelman

Pollock²,

Kreutzer

et al. 1998

Neonatology

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“…This probably refl ects the severity of hydrops precipitating early delivery rather than a direct consequence of prematurity per se. A poor outcome has been well described following antenatal detection of hydrops before 24 weeks gestation [5,11] .…”

Section: Discussionmentioning

confidence: 99%

Severity of Non-Immune Hydrops Fetalis at Birth Continues to Predict Survival despite Advances in Perinatal Care

Simpson

McDevitt²,

Young³

et al. 2006

Fetal Diagn Ther

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Objectives: To describe the aetiology and short-term outcome of live-born infants with non-immune hydrops fetalis (NIH), to identify predictors of mortality and to establish whether there has been any change in mortality over a 14-year period. Methods: A retrospective case note review of all liveborn neonates with NIH. Results: 30 infants were identified. Twenty (66%) had an identifiable aetiology. Ten (33%) survived to discharge. Survivors had significantly higher Apgar scores at 1 and 5 min (both p < 0.001). Mortality did not differ between the time periods 1990–1999 and 2000–2004. Conclusions: NIH continues to be associated with a significant mortality despite advances in perinatal care. Poor condition at birth is a strong predictor of death.

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“…For cases of fetal infection, intrauterine blood transfusions may be beneficial (Schwarz et al, 1988a;Hansmann et al, 1989), especially in the case of hydrops, but this procedure does involve additional risks to the outcome of pregnancy (Berry et al, 1992;Cameron et al, 1997;Bousquet et al, 2000). A study by Wattre et al (1998) reported two cases where intrauterine blood transfusions led to the cessation of symptoms and the birth of normal babies.…”

Section: B19 Infection and Pregnancymentioning

confidence: 99%

Advances in the biology, diagnosis and host–pathogen interactions of parvovirus B19

Corcoran

Doyle

2004

Journal of Medical Microbiology

153

103

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Increased recognition of parvovirus B19 (B19), an erythrovirus, as a significant human pathogen that causes fetal loss and severe disease in immunocompromised patients has resulted in intensive efforts to understand the pathogenesis of B19-related disease, to improve diagnostic strategy that is deployed to detect B19 infection and blood-product contamination and, finally, to elucidate the nature of the cellular immune response that is elicited by the virus in diverse patient cohorts. It is becoming clear that at least three related erythrovirus strains (B19, A6/K71 and V9) are circulating in the general population and that viral entry into target cells is mediated by an expanding range of cellular receptors, including P antigen and â-integrins. Persistent infection by B19 is emerging as a contributory factor in autoimmune disease, a hypothesis that is constrained by the detection of B19 in the skin of apparently healthy individuals. B19 infection during pregnancy may account for thousands of incidences of fetal loss per annum in Europe, North America and beyond, yet there is currently only minimal screening of pregnant women to assess serological status, and thereby risk of infection, upon becoming pregnant. Whilst major advances in diagnosis of B19 infection have taken place, including standardization of serological and DNA-based detection methodologies, blood donations that are targeted at high-risk groups are only beginning to be screened for B19 IgG and DNA as a means of minimizing exposure of at-risk patients to the virus. It is now firmly established that a Th1-mediated cellular immune response is mounted in immunocompetent individuals, a finding that should contribute to the development of an effective vaccine to prevent B19 infection in selected high-risk groups, including sickle-cell anaemics. Parvovirus B19In 1975, Yvonne Cossart discovered what was to become known as human parvovirus B19 (B19) (Cossart et al., 1975). B19 was first associated with disease in 1981, when it was linked to an aplastic crisis in a patient with sickle-cell disease. It has since been shown to cause erythema infectiosum (EI) (fifth disease of childhood), spontaneous abortion and some forms of acute arthritis (Anderson et al., 1983; Kinney et al., 1988;Woolf & Cohen, 1995).B19 is a small, non-enveloped, ssDNA virus and, like all parvoviruses, the capsid proteins are arranged with icosahedral symmetry. B19 is 20-25 nm in diameter and has a genome of 5 . 6 kb (Clewley, 1984;Cotmore & Tattersall, 1984). The B19 capsid consists of an 83 kDa minor structural protein, VP1, and a 5 kDa major structural protein, VP2. VP2 makes up about 95 % of the total capsid, with VP1 accounting for the remaining 5 % . The sequences of the two proteins are collinear, with VP2 being identical to the carboxyl-terminus of VP1; however, VP1 comprises an additional 227 aa domain that is unique to the amino-terminal (Fig. 1). To the left of these sequences on the B19 genome is the ORF for a non-structural protein, NS1, which encodes a protein product of 7...

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New Therapeutic Aspects in Nonimmune Hydrops fetalis Based on Four Hundred and Two Prenatally Diagnosed Cases

Cited by 46 publications

References 13 publications

Nonimmune Hydrops fetalis: Fetal and Neonatal Outcome during 1983–1992

Nonimmune Hydrops fetalis: Fetal and Neonatal Outcome during 1983–1992

Severity of Non-Immune Hydrops Fetalis at Birth Continues to Predict Survival despite Advances in Perinatal Care

Advances in the biology, diagnosis and host–pathogen interactions of parvovirus B19

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