Prognostic Factors and Clinical Features in Liveborn Neonates with Hydrops Fetalis

ArticleinAmerican Journal of Perinatology 24(1):33-8 · February 2007with9 Reads
DOI: 10.1055/s-2006-958158 · Source: PubMed
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.
    • "In our series, the mortality rate in hydropic neonates was 53.3%. Huang et al. found that hydrops resulting from lymphatic dysplasias had a more favorable outcome [36]; that association was not found in our sample. "
    [Show abstract] [Hide abstract] ABSTRACT: Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.The authors performed a retrospective study in the Neonatal Intensive Care Unit of "Hospital de São João", Porto (Portugal), between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN).Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2%) newborns and acquired in 63 (76.8%). Fetal hydrops was the most frequent cause (15 cases, 78.9%) of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9%) of acquired effusions, followed by leakage of TPN (13 cases, 20.6%). Chylothorax was the most common type of effusion (41.5% of cases). Pleural effusions after intrathoracic surgery were mainly (64.1%) chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9%) newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.
    Full-text · Article · Apr 2015
    • "Historically, hydrops was felt to be a harbinger of fetal demise, but advancements in fetal treatment have improved outcomes for diseases such as primary hydrothorax [7] and chest masses [8] [9] [10]. Nevertheless, mortality still approaches 40%–50% when considering hydropic fetuses overall [3] [11] [12] and predicting survival remains a challenge. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Fetal hydrops arises from multiple disease processes and can portend a grim prognosis. We reviewed our experience with hydropic fetuses to understand relevant antenatal anatomic and physiologic predictors of survival. Methods: We reviewed fetal ultrasounds and echocardiograms of hydropic fetuses evaluated from 1996 to 2013. Results: Overall neonatal survival in 167 fetuses was 44% (range, 0-75%) and was influenced by the underlying disease process. The anatomic distribution of fluid varied and was not significantly different between survivors and nonsurvivors. Univariate analysis indicated that resolution of hydrops and delivery at a later gestational age were predictive of survival (OR: 5.7 (95% CI: 2.5-13.2) and OR: 1.3 (95% CI: 1.1-1.4), respectively). Fetal intervention also improved survival in some diseases. Echocardiograms were reviewed to group fetuses with similar cardiac physiology and defined categories with high or low/normal cardiothoracic ratio (CTR). Among patients with a high CTR, the cardiovascular profile score was predictive of survival (p=0.009). Conclusion: Survival in hydrops depends on the underlying disease, available fetal therapies to resolve hydrops, and the gestational age of delivery and not on the specific anatomic manifestations of hydrops. In hydropic fetuses with high CTRs, the cardiovascular profile score may be a useful prognostic indicator.
    Full-text · Article · Oct 2014
    • "More recent recognition of factors other than isoimmune hemolytic disease that can cause or be associated with hydrops fetalis led to the use of the term non-immunological hydrops fetalis (NIHF). Currently, NIHF (reported incidence of 1 in 2000–3000 pregnancies [3]) is more common, comprising 85-90% of all described cases [4,5]. The precise incidence of hydrops fetalis is difficult to elucidate, because many cases are not detected prior to intrauterine fetal death and some cases may resolve spontaneously in utero. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Lysosomal storage disorders (LSD) are a rare cause of non immunological hydrops fetalis (NIHF) and congenital ascites. The reported incidence is about 1%. The incidence of idiopathic NIHF is estimated to be about 18%. Patients and methods We report four cases with transient hydrops fetalis resulting from LSD and performed a literature review on LSD with NIHF and congenital ascites in combination. Results At present, 12 different LSDs are described to be associated with NIHF or congenital ascites. Most patients had a family history of NIHF, where the preceding sibling had not been examined. A diagnostic approach to the fetus with NIHF due to suspected LSD either in utero or postnatal is suggested. Transient forms of NIHF and/or ascites in association with MPS IVA, MPS VII and NPC are described for the first time in this publication. Conclusions LSD should be considered in transient hydrops. Enzymatic studies in chorionic villous sample or amniotic cultured cells, once the most common conditions associated with fetal ascites or hydrops have been ruled out, are important. This paper emphasizes the fact that LSD is significantly higher than the estimated 1% in previous studies, which is important for genetic counseling as there is a high risk of recurrence and the availability of enzyme replacement therapy for an increasing number of LSD.
    Full-text · Article · Nov 2012
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