Am J Perinatol 2007; 24(1): 033-038
DOI: 10.1055/s-2006-958158
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Prognostic Factors and Clinical Features in Liveborn Neonates with Hydrops Fetalis

Hsuan-Rong Huang1 , Pei-Kwei Tsay2 , Ming-Chou Chiang1 , Reyin Lien1 , Yi-Hung Chou1
  • 1Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
  • 2Department of Public Health and Center of Biostatistics, Chang Gung University College of Medicine, Taoyuan, Taiwan
Further Information

Publication History

Publication Date:
27 December 2006 (online)

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.

REFERENCES

  • 1 Santolaya J, Alley D, Jaffe R, Warsof S L. Antenatal classification of hydrops fetalis.  Obstet Gynecol. 1992;  79 256-259
  • 2 Heinonen S, Ryynanen M, Kirkinen P. Etiology and outcome of second trimester non-immunologic fetal hydrops.  Acta Obstet Gynecol Scand. 2000;  79 15-18
  • 3 Wy C A, Sajous C H, Loberiza F, Weiss M G. Outcome of infants with a diagnosis of hydrops fetalis in the 1990s.  Am J Perinatol. 1999;  16 561-567
  • 4 McCoy M C, Katz V L, Gould N, Kuller J A. Non-immune hydrops after 20 weeks' gestation: review of 10 years' experience with suggestions for management.  Obstet Gynecol. 1995;  85 578-582
  • 5 Sohan K, Carroll S G, De La Fuente S, Soothill P, Kyle P. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment.  Acta Obstet Gynecol Scand. 2001;  80 726-730
  • 6 Wafelman L S, Pollock B H, Kreutzer J, Richards D S, Hutchison A A. Nonimmune hydrops fetalis: fetal and neonatal outcome during 1983-1992.  Biol Neonate. 1999;  75 73-81
  • 7 Forouzan I. Hydrops fetalis: recent advances.  Obstet Gynecol Surv. 1997;  52 130-138
  • 8 Barker P M, Esther Jr C R, Fordham L A, Maygarden S J, Funkhouser W K. Primary pulmonary lymphangiectasia in infancy and childhood.  Eur Respir J. 2004;  24 413-419
  • 9 Rocha G, Fernandes P, Rocha P, Quintas C, Martins T, Proenca E. Pleural effusions in the neonate.  Acta Paediatr. 2006;  95 791-798
  • 10 Allan L D, Sharland G K, Chita S K, Lockhart S, Maxwell D J. Chromosomal anomalies in fetal congenital heart disease.  Ultrasound Obstet Gynecol. 1991;  1 8-11
  • 11 Iskaros J, Jauniaux E, Rodeck C. Outcome of nonimmune hydrops fetalis diagnosed during the first half of pregnancy.  Obstet Gynecol. 1997;  90 321-325
  • 12 Jauniaux E. Diagnosis and management of early non-immune hydrops fetalis.  Prenat Diagn. 1997;  17 1261-1268
  • 13 Hartung J, Chaoui R, Kalache K, Tennstedt C, Bollmann R. Prenatal diagnosis of intrahepatic communications of the umbilical vein with atypical arteries (A-V fistulae) in two cases of trisomy 21 using color Doppler ultrasound.  Ultrasound Obstet Gynecol. 2000;  16 271-274
  • 14 Rodríguez M M, Chaves F, Romaguera R L, Ferrer P L, de la Guardia C, Bruce J H. Value of autopsy in nonimmune hydrops fetalis: series of 51 stillborn fetuses.  Pediatr Dev Pathol. 2002;  5 365-374
  • 15 Rodríguez M M, Bruce J H, Jimenez X F et al.. Nonimmune hydrops fetalis in the liveborn: series of 32 autopsies.  Pediatr Dev Pathol. 2005;  8 369-378
  • 16 Wu K H, Chu S L, Chang J G, Shin M C, Peng C T. Hemolytic disease of the newborn due to maternal irregular antibodies in the Chinese population in Taiwan.  Transfus Med. 2003;  13 311-314
  • 17 De Young-Owens A, Kennedy M, Rose R L, Boyle J, O'Shaughnessy R. Anti-M isoimmunization: management and outcome at the Ohio State University from 1969 to1995.  Obstet Gynecol. 1997;  90 962-966
  • 18 Klam S, Bigras J L, Hudon L. Predicting outcome in primary fetal hydrothorax.  Fetal Diagn Ther. 2005;  20 366-370
  • 19 Zenker M, Ries M. Hydrops fetalis caused by chylothorax: an exception to the rule.  J Perinat Med. 1997;  25 388
  • 20 Faul J L, Berry G J, Colby T V et al.. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasia syndrome.  Am J Respir Crit Care Med. 2000;  161 1037-1046
  • 21 Mussat P, Dommergues M, Parat S et al.. Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis.  Acta Paediatr. 1995;  84 749-755
  • 22 Nakayama H, Kukita J, Hikino S, Nakano H, Hara T. Long-term outcome of 51 liveborn neonates with non-immune hydrops fetalis.  Acta Paediatr. 1999;  88 24-28
  • 23 Simpson J H, McDevitt H, Young D, Cameron A D. Severity of non-immune hydrops fetalis at birth continues to predict survival despite advances in perinatal care.  Fetal Diagn Ther. 2006;  21 380-382
  • 24 Phibbs R H, Johnson P, Kitterman J A, Gregory G A, Tooley W H. Cardiorespiratory status of erythroblastotic infants. I. Relationship of gestational age, severity of hemolytic diseases, and birth asphyxia to idiopathic respiratory distress syndrome and survival.  Pediatrics. 1972;  49 5-14
  • 25 Phibbs R H, Johnson P, Tooley W H. Cardiorespiratory status of erythroblastotic newborn infants. II. Blood volume, hematocrit and serum albumin concentration in relation to hydrops fetalis.  Pediatrics. 1974;  53 13-23
  • 26 Shimokawa H, Hara K, Maeda H, Miyamoto S, Koyanagi T, Nakano H. Intrauterine treatment of idiopathic hydrops fetalis.  J Perinat Med. 1988;  16 133-138

Ming-Chou ChiangM.D. 

Division of Neonatology, Department of Pediatrics Chang Gung Memorial Hospital, Chang Gung University College of Medicine 5, Fushing Street

Gueishan Shiang, Taoyuan, Taiwan 333, Republic of China

    >