Long-term neurodevelopmental outcome and brain volume after treatment for hydrops fetalis by in utero intravascular transfusion

• Published in: American journal of obstetrics and gynecology Vol. 195; no. 1; pp. 192 - 200
• Main Authors: Harper, Dennis C., Swingle, Hanes M., Weiner, Carl P., Bonthius, Daniel J., Aylward, Glen P., Widness, John A.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.07.2006; Elsevier
• Subjects: Anemia; Anemias. Hemoglobinopathies; Biological and medical sciences; Blood Transfusion, Intrauterine - methods; Brain - physiopathology; Child; Diseases of mother, fetus and pregnancy; Diseases of red blood cells; Female; Fetus; Follow-Up Studies; Gestational Age; Gynecology. Andrology. Obstetrics; Hematocrit; Hematologic and hematopoietic diseases; Hemolytic disease; Humans; Hydrops; Hydrops Fetalis - mortality; Hydrops Fetalis - physiopathology; Hydrops Fetalis - therapy; Intrauterine blood transfusion; Medical sciences; Neuropsychological Tests; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Intrauterine blood transfusion; Fetus; Hydrops; Hemolytic disease; Anemia; Psychomotor development; Transfusion; Pregnancy disorders; Gynecology; Central nervous system; Hemopathy; In utero; Long term; Obstetrics; Blood; Encephalon; Fetal diseases; Hemolytic anemia; Hydrops fetalis; Volume; Blood vessel; Circulatory system; Fetal therapy
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2005.12.012

We tested the hypothesis that long-term neurodevelopmental outcomes of successfully treated fetuses with immune hydrops are similar to their unaffected siblings according to a protocol that addresses the underlying pathophysiologic condition. Sixteen of 18 consecutive hydropic fetuses (89%) who were treated in a dedicated fetal medicine unit between July 1985 and October 1995 survived. The transfusion protocol used a 2-step correction over a 2 to 4 day interval, combined with umbilical venous pressure measurements to avoid over transfusion and bicarbonate administration to assure a posttransfusion UV pH of >7.30. Survivors were evaluated at a mean age of 10 years. Statistical analyses included t-test, Wilcoxon rank-sum test, Fisher's exact test, and Pearson coefficients. Overall, death or major neurologic morbidity occurred in 4 of 18 of the fetuses (22%) who were treated (2/16 of survivors [12.5%]). Among the survivors, the children with immune hydrops had physical, neurologic, and cognitive outcomes statistically similar to their siblings, except for a measure of visual attention. Two of the children (12%) had major neurologic sequelae. Brain volumes were statistically smaller than unrelated control subjects by 8.8%, but these control subjects were not matched for height at testing or gestational age at birth. Both groups had brain volumes within the normal range. Intravascular transfusion of fetuses with profoundly anemic immune hydrops results in high survival rates and favorable long-term neuropsychological outcomes.