OUTCOME OF INFANTS WITH A DIAGNOSIS OF HYDROPS FETALIS IN THE 1990s

Abstract

The diagnosis of Hydrops fetalis still carries a grave prognosis with reported mortality ranging from 50 to 100%. With the advent of more aggressive therapy, improvement of survival is undetermined. The study population of this outcome case series was gathered from all cases of hydrops fetalis admitted to our Loyola University Medical Center Neonatal Intensive Care Unit (NICU) from 1990 to 1997. Forty-one patients were eligible for inclusion. Only four had a diagnosis of immune hydrops fetalis, while the remainder had varied nonimmune causes. Models predicting survival were constructed with various neonatal and maternal factors as explanatory variables using Cox proportional Hazards technique. Kaplan-Meier estimates of median survival times for different stratifying variables were likewise computed. The overall mortality rate was 49% with an overall median survival time of 15 days (95% CI 8-38). Median survival time estimates differed significantly between patients who had (a) proven infection or not and (b) had less than or greater than two fluid-filled cavities. The use of steroids, surfactant, or high-frequency ventilation did not improve survival. Stratifying the study base into those treated in early or late 1990s likewise failed to show difference in survival times. Infection remains a significant problem (46%). In our series of 41 infants with hydrops fetalis, survival rates remain comparable to those reported in the literature, despite aggressive therapy. Although the use of surfactant, steroids, and high-frequency ventilation appear to prolong survival times, these treatments failed to alter overall survival outcome.

Severity of Non-Immune Hydrops Fetalis at Birth Continues to Predict Survival despite Advances in Perinatal Care

“…Within our study group survival was similar for infants delivered between 1990 and 1999 and those delivered between 2000 and 2004. Administration of antenatal steroids did not infl uence outcome, a fi nding corroborated by others [6] , who also failed to identify any benefi cial effect on survival from administration of surfactant or use of high frequency oscillatory ventilation [6] . This probably refl ects the complex underlying pathophysiology of NIH and the fact that it represents the terminal stage of a wide variety of conditions [1] .…”

“…A number of surrogate markers of severe hydrops including 6 2 fl uid-fi lled serous cavities [5,6] , presence of pleural effusions [4,10] , and need for chest compressions at birth [5] have been associated with a poor outcome. We demonstrated a very strong correlation between Apgar scores at one and fi ve minutes and death.…”

“…More recent data from the mid-1980s to the mid1990s demonstrates a reduced mortality of 40-60% [4][5][6] . There are no published outcome studies of liveborn infants with NIH delivered since 2000.…”

Hidropisia fetal: análise de 80 casos

“…Cerca de 40% dos casos de hidropisia fetal não imune não tiveram etiologia determinada em nosso estudo. Estes valores são mais elevados que os relatados na literatura em diversas séries 5,7,15 . Isto pode ser explicado, em parte, pela baixa utilização da análise do cariótipo como ferramenta diagnóstica (apenas 11% de solicitação).…”

Characteristics of congenital cystic adenomatoid malformations associated with nonimmune hydrops and outcome

“…perinatal mortality rates at tertiary institutions [1][2][3][4][5][6][7][8][9][10]. Despite rare reports of spontaneous resolution of hydrops in fetuses with CCAM, once hydrops has developed, reported survival rate is less than 10% [5,[10][11][12].…”