Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Abstract

Background and objectives: Intrauterine blood transfusion (IUT) performed for fetal anemia may be associated with adverse neonatal outcomes. This study aimed to describe the clinical outcome of surviving neonates treated with IUT in an area where detailed outcome on neonatal data is limited. Patients and methods:This prospective study included all living newborns treated with IUT at our institution between March 2004 and February 2011. During this period, 30 newborns with a mean gestation age of 35 weeks (range: 25-37 weeks) were admitted with various respiratory, hematological and gastrointestinal morbidities. Results:The survival rate on discharge was 93%. Severe fetal anemia (72.2%) was significantly associated with a low reticulocyte count at birth and the need for respiratory support after birth (P<0.05). The number of IUTs was significantly correlated with the duration of admission (P=0.034) and the presence of hyporegenerative late anemia (P=0.007), but not with other neonatal outcomes or with a low reticulocyte count at birth. Use of intravenous immunoglobulin was significantly associated with an increased rate of top-up transfusion for late anemia and a decreased duration of admission, with no additional positive effects. Conclusion:This study provides evidence on the types of potential neonatal morbidities after IUT therapy and their risk factors, and could be useful to clinicians treating fetuses with intrauterine transfusions and also for counseling parents.

Chelation therapy for secondary neonatal iron over load: Lessons learned from rhesus hemolytic disease

“…Several studies showed the incidence of cholestasis in neonatal hemolytic disease to be 13-20% of all patients. 3,4 To our knowledge, for neonates with RHD and cholestatic liver disease, there are only four case reports in the literature that reviewed a specific treatment. [5][6][7][8] This consists of chelation therapy with the usage of intravenous Deferoxamine.…”

“…Hyporegenerative anemia is a known complication with RHD and IUT. 4,14 Iron supplements with erythropoietin are, therefore, given. However, when iron overload is a concern, like in our case, iron supplement should be discontinued.…”

“…Intrauterine transfusions (IUT) have been used in the management of such severe cases of intrauterine anemia. 2 Several studies have discussed the neonatal outcomes for RHD patients who underwent IUTs 3,4 , with the associated complications, like liver injury, cholestasis and hypo-regenerative anemia. Yet, only four reports addressed the use of chelation therapy for the treatment of secondary iron overload in this patient group.…”