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

Harper, Dennis C.; Swingle, Hanes M.; Weiner, Carl P.; Bonthius, Daniel J.; Aylward, Glen P.; Widness, John A.

doi:10.1016/j.ajog.2005.12.012

Cited by 45 publications

(28 citation statements)

References 21 publications

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“…One long-term concern of IUT is that advances in treatment techniques have allowed more hydropic fetuses to survive, and these infants may be at higher risk of long-term morbidity. In a few small studies, the incidence of severe adverse long-term outcome ranges from 2.8 to 13% [17,18,19]. Recently, a larger follow-up study (LOTUS study) analyzed outcome after a total of 1,284 IUTs performed in 451 fetuses in a 20-year period [20].…”

Section: Indications For Iutmentioning

confidence: 99%

Intrauterine Blood Transfusion: Current Indications and Associated Risks

Lindenburg

Kamp

Oepkes³

2014

Fetal Diagn Ther

137

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Fetal anemia is a serious complication in pregnancy and associated with perinatal mortality and morbidity. During 25 years of worldwide experience with intravascular intrauterine blood transfusion, a variety of indications have been described. Intrauterine transfusion (IUT) treatment is considered most successful for fetal anemia due to red cell alloimmunization. Moreover, the use of this procedure has also been reported in pregnancies with parvovirus B19 infection, fetomaternal hemorrhage and placental chorioangiomas, for example. This review focuses on the current indications of intrauterine blood transfusions. In addition, we describe the potential complications of IUT treatment.

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Section: Indications For Iutmentioning

confidence: 99%

Intrauterine Blood Transfusion: Current Indications and Associated Risks

Lindenburg

Kamp

Oepkes³

2014

Fetal Diagn Ther

137

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“…Normal developmental outcome during standardized developmental assessments in the fi rst 62 months was observed for children treated with IUTs for severe fetal hemolytic disease [32] . In a study of 16 hydropic patients who were evaluated at a mean age of 10 years, the incidence of severe neurologic morbidity was estimated to be 12.5 % [31] . In a recent (2012) study by the LOTUS study group [41] , a total of 291 children were evaluated at a median age of 8.2 years.…”

Section: Complications and Short-or Long-term Outcomementioning

confidence: 99%

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

Παπαντωνίου

Sifakis

Antsaklis

2012

Journal of Perinatal Medicine

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Fetal anemia, mainly due to red cell alloimmunization, is still a signifi cant cause of fetal and neonatal mortality and morbidity. The focus of current clinical research has shifted from an invasive approach to non-invasive management and treatment of affected pregnancies, and the progress in this fi eld is associated with a major improvement in perinatal outcome. During the last 50 years, intrauterine red cells transfusion (IUT), fi rst via the intraperitoneal route and later directly to fetal circulation, is the standard practice in most centers, with survival rates that exceed 90 % , particularly if anemia is diagnosed early and treated in a timely manner. In addition, plasmapheresis and intravenous administration of highdose immunoglobulin have been implicated in the treatment of pregnancies complicated with early-onset severe red cell alloimmunization, alone or in combination with IUTs before the 20 th week of pregnancy, but there are still issues to be clarifi ed further. This review article aims to provide an overview of the current standard therapeutic management and alternative treatment modalities in pregnancies complicated by fetal anemia.

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“…Surviving children may require simple or exchange RBC transfusion, intravenous immunoglobulin, and/or phototherapy; severely affected children may be affected by developmental delay and cerebral palsy. 6,7 With the exception of polyclonal anti-D (RhoGam), there are no known therapies to prevent RBC alloimmunization or to mitigate the dangers of existing RBC alloantibodies. With the introduction of anti-D, Rh(D) pregnancy associated alloimmunization has decreased by 95%.…”

Section: Introductionmentioning

confidence: 99%

Alloantibodies to a paternally derived RBC KEL antigen lead to hemolytic disease of the fetus/newborn in a murine model

Stowell

Henry

Smith

et al. 2013

Blood

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• Anti-KEL alloantibodies generated after exposure to paternally derived RBC antigens during pregnancy result in fetal anemia.• This is the first animal model of pregnancy associated HDFN, with transfusion and pregnancy resulting in boostable anti-KEL alloantibodies.Exposure to nonself red blood cell (RBC) antigens, either from transfusion or pregnancy, may result in alloimmunization and incompatible RBC clearance. First described as a pregnancy complication 80 years ago, hemolytic disease of the fetus and newborn (HDFN) is caused by alloimmunization to paternally derived RBC antigens. Despite the morbidity/mortality of HDFN, women at risk for RBC alloimmunization have few therapeutic options. Given that alloantibodies to antigens in the KEL family are among the most clinically significant, we developed a murine model with RBC-specific expression of the human KEL antigen to evaluate the impact of maternal/fetal KEL incompatibility. After exposure to fetal KEL RBCs during successive pregnancies with KEL-positive males, 21 of 21 wild-type female mice developed anti-KEL alloantibodies; intrauterine fetal anemia and/or demise occurred in a subset of KEL-positive pups born to wild type, but not agammaglobulinemic mothers. Similar to previous observations in humans, pregnancy-associated alloantibodies were detrimental in a transfusion setting, and transfusion-associated alloantibodies were detrimental in a pregnancy setting. This is the first pregnancy-associated HDFN model described to date, which will serve as a platform to develop targeted therapies to prevent and/or mitigate the dangers of RBC alloantibodies to fetuses and newborns. (Blood. 2013;122(8):1494-1504

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

Cited by 45 publications

References 21 publications

Intrauterine Blood Transfusion: Current Indications and Associated Risks

Intrauterine Blood Transfusion: Current Indications and Associated Risks

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

Alloantibodies to a paternally derived RBC KEL antigen lead to hemolytic disease of the fetus/newborn in a murine model

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