Prognostic Factors and Clinical Features in Liveborn Neonates with Hydrops Fetalis

Abstract

The purpose of this study was to delineate the etiology and the clinical features of liveborn neonates with hydrops fetalis, and to explore the prognostic factors for survival. Medical records of 28 liveborn neonates with hydrops fetalis between April 1995 and March 2005 were reviewed retrospectively. Demographic data, clinical manifestations, laboratory findings, and outcomes were analyzed. Most patients presented with pleural effusions (21 of 28) and ascites (22 of 28). The majority of patients had hydrops due to cardiovascular diseases (seven of 28), hematologic disorders (six of 28), lymphatic malformations (six of 28), and idiopathic origins (six of 28). The overall survival rate was 50% and was highest (83%) in infants with lymphatic malformations. By univariate analysis, risk factors for mortality are earlier ages at diagnosis and at birth, low Apgar scores, need for resuscitation in the delivery room, low serum albumin level, and severe acidemia. After using stepwise multiple logistic regression analysis, the most significant factors associated with fatality were younger gestational age at birth and lower serum albumin level. Hydrops fetalis remains a complex condition with a high mortality rate. Hydrops resulting from lymphatic malformations has a favorable outcome. Preterm birth at less than 34 weeks and serum albumin concentration lower than 2 g/dL are two poor prognostic factors for survival.

Hydrops Fetalis: A Retrospective Review of Cases Reported to a Large National Database and Identification of Risk Factors Associated With Death

“…Most previous studies had sample sizes of Ͻ100 patients, and only 2 of them attempted to identify risk factors associated with death. 1,21-24 Similar to results reported by previous investigators, 1,22 we noted that the prognosis for hydrops fetalis depended on the cause. In our data, the mortality rate was highest among neonates with congenital anomalies (mortality rate: 57.7%) and lowest among neonates with congenital chylothorax (mortality rate: 5.9%).…”

“…[1][2][3][4][5][6][7] Hydrops, an end-stage process for a number of fetal diseases, results in tissue edema and effusions of multiple body cavities. The cause of hydrops fetalis is multifactorial, and the condition is often associated with high mortality rates, despite improvements in diagnosis and management.…”

“…The cause of hydrops fetalis is multifactorial, and the condition is often associated with high mortality rates, despite improvements in diagnosis and management. 1,7,8 Because of early prenatal diagnosis and intervention, Rh disease is now a relatively uncommon cause of hydrops fetalis in neonates. Underlying mechanisms such as cardiac disease and arrhythmias are relatively straightforward to diagnose, whereas other disorders, such as lysosomal storage diseases, require careful investigation and specialty laboratories.…”

Hydrops fetalis – has there been a change in diagnostic spectrum and mortality?

“…HF carries a poor prognosis with high mortality and may result in intrauterine or early postnatal death, sometimes directly in the delivery room [1][2][3].…”

Congenital chylothorax: current perspectives and trends

“…29 Lymphangiectasia and other congenital lymphatic malformations (lymphatic dysplasia syndrome, lymphangiomas, and cervical or cystic hygromas) can also present with chylothorax/bilateral pleural effusions, and NIHF as a result of obstruction in lymphatic flow. [31][32][33] Cystic hygromas are commonly associated with complex aberrations of the lymphatics and cause mass compression effects that impede both lymphatic drainage and venous return to the heart. 34 During the postnatal period, chylous pleural effusion can lead to ongoing pressure effects impeding adequate ventila- …”