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

Abstract

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.

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

“…30 weeks survived. Wafelman et al [5] described a similar non-signifi cant association between gestational age at delivery and survival [5] . This probably refl ects the severity of hydrops precipitating early delivery rather than a direct consequence of prematurity per se.…”

“…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] .…”

“…A number of surrogate markers of severe hydrops including 6 2 fl uid-fi lled serous cavities [5,6] , presence of pleural effusions [4,10] , and need for chest compressions at birth [5] have been associated with a poor outcome. We demonstrated a very strong correlation between Apgar scores at one and fi ve minutes and death.…”

“…More recent data from the mid-1980s to the mid1990s demonstrates a reduced mortality of 40-60% [4][5][6] . There are no published outcome studies of liveborn infants with NIH delivered since 2000.…”

“…These include the presence of pleural effusions [4] , the need for chest compressions at delivery [5] , and the absence of an identifi able aetiology [4] .…”