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Published on: August 25, 2022
Long-term neurodevelopmental outcome and brain volume after treatment for hydrops fetalis by in utero intravascular
Dennis C Harper1, Hanes M Swingle, Carl P Weiner
1Department of Pediatric, The University of Iowa, College of Medicine, Iowa City, IA 52242-1011, USA.
Insights
Successfully treated fetuses with immune hydrops show favorable long-term neurodevelopmental outcomes, comparable to siblings. This study highlights the effectiveness of specialized treatment protocols for fetal anemia.
Area of Science:
- Perinatology
- Fetal Medicine
- Neurodevelopmental Outcomes
Background:
- Immune hydrops fetalis is a severe condition requiring specialized treatment.
- Understanding long-term neurodevelopmental outcomes is crucial for assessing treatment efficacy.
Purpose of the Study:
- To evaluate the long-term neurodevelopmental outcomes of fetuses treated for immune hydrops.
- To compare outcomes of treated survivors with their unaffected siblings.
Main Methods:
- A cohort of 18 hydropic fetuses treated with a specific transfusion protocol were analyzed.
- Survivors were assessed at a mean age of 10 years, with statistical comparisons to siblings.
Main Results:
- High survival rate (89%) was achieved with the specialized transfusion protocol.
- Survivors demonstrated neurodevelopmental outcomes statistically similar to siblings, with few exceptions.
- Minor differences in brain volume were observed but remained within normal ranges.
Conclusions:
- Intravascular transfusion protocols lead to high survival rates in fetuses with immune hydrops.
- Favorable long-term neuropsychological outcomes are achievable with appropriate fetal treatment.
Objective:
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.
Study Design:
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.
Results:
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.
Conclusion:
Intravascular transfusion of fetuses with profoundly anemic immune hydrops results in high survival rates and favorable long-term neuropsychological outcomes.
