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

Abstract

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.

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

“…In contrast to the literature, the survivor and nonsurvivor groups in our study showed no significant difference in the presence of serous cavity effusions, although there was a trend towards the presence of pleural effusions at delivery in patients who died [10,18,60,61]. These findings reflect that though intervention with pleural drainage is necessary for survival, the etiology of fluid accumulation is the primary decisive factor.…”

“…These findings are similar to the reports describing various antenatal and postnatal prognostic indicators in NIH [9,10,[18][19][20]58]. Gestational age was significantly associated with the mortality rate in our patients in contrast to Wafelman et al and Simpsom et al, respectively, although seven infants delivered at 5 30 weeks survived in our study.…”

“…Furthermore, we observed very poor outcome for unexplained cases, 30% in this series, which is consistent with the results of other reports [10,11,18,22]. Here most patients were affected by prematurity and fluid accumulation, which compresses the developing fetal lung and precluses its normal development, leading to higher mortality than in other etiologic categories for HF.…”

Prenatal Findings in Congenital Leukemia: A Case Report

“…Hydrops fetalis is generally associated with poor prognosis [10] . Two distinct mechanisms could be considered for hydrops development caused by fetal leukemia.…”

Fetal pleural effusion and Down syndrome

“…Steps include identification of maternal blood type and screening serum specific antibodies to exclude immune hydrops, detection of infectious factors including TORCH, syphilis, and parvovirusB19, and performing a K-B test to exclude fetal maternal transfusion syndrome. A careful ultrasound examination should also be performed to observe the placenta, amniotic fluid, and fetal structure (and especially the fetal heart), and pulse Doppler should be used to detect the blood flow spectrum of the umbilical artery, middle cerebral artery, and venous system (16,17). Karyotyping or genetic testing is also routinely performed, especially in fetuses in which early pleural effusion has been detected (18-21).…”