C Garabedian1, T Rakza2, D Thomas3, B Wibaut4, P Vaast5, D Subtil6,7, V Houfflin-Debarge8,9. 1. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. charles.garabedian@chru-lille.fr. 2. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. Thameur.rakza@chru-lille.fr. 3. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. dominique.thomas@chru-lille.fr. 4. Institute of Hematology and Transfusion, Jeanne de Flandre Hospital, CHRU of Lille, Lille, France. benedicte.wibaut@chru-lille.fr. 5. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. pascal.vaast@chru-lille.fr. 6. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. Damien.subtil@chru-lille.fr. 7. University of Lille-North of France, Lille, France. Damien.subtil@chru-lille.fr. 8. Department of Obstetrics, Jeanne de Flandre Hospital, Regional University Hospital Center (CHRU) of Lille, Lille, France. Veronique.debarge@chru-lille.fr. 9. University of Lille-North of France, Lille, France. Veronique.debarge@chru-lille.fr.
Abstract
UNLABELLED: In-utero transfusion is now well under control and improves the survival of foetuses monitored for fetal anemia with a survival rate of more than 80 %. The aim was to evaluate short-term neonatal outcome after fetal severe anemia managed by intrauterine transfusions. We did a retrospective study of all neonates born after management of severe fetal anemia (n = 93) between January 1999 and January 2013 in our regional center. The two main causes of anemia were maternal red blood cell alloimmunization (N = 81, 87 %) and Parvovirus B19 infection (N = 10, 10.8 %). In the alloimmunization group, phototherapy was implemented in 85.2 % of cases with a maximum level of bilirubin of 114.4 ± 60.7 (mg/dl). Transfusion and exchange transfusion were, respectively, required in 51.9 % and in 34.6 % of cases. One neonate presented a convulsive episode, and we observed three neonatal deaths. In the parvovirus group, none of the child had anemia at birth and no management was necessary. CONCLUSION: Contemporary management of Rhesus disease is associated with encouraging neonatal outcomes. In case of Parvovirus infection, no specific management is necessary at. But, in all cases of fetal anemia, children should be followed up with particular attention to neurologic development. WHAT IS KNOWN: • In-utero transfusion is now well under control and improves the survival of fetuses monitored for fetal anemia. • Limited studies are available on the effect of IUT on postnatal outcome in infants with a history of fetal anemia. What is New: • Contemporary management of severe Rhesus disease is associated with encouraging neonatal outcomes. • The majority of infants can be managed with phototherapy and a limited number of top-up transfusions and exchange transfusions. In case of Parvovirus infection, the short-term neonatal outcome is excellent.
UNLABELLED: In-utero transfusion is now well under control and improves the survival of foetuses monitored for fetal anemia with a survival rate of more than 80 %. The aim was to evaluate short-term neonatal outcome after fetal severe anemia managed by intrauterine transfusions. We did a retrospective study of all neonates born after management of severe fetal anemia (n = 93) between January 1999 and January 2013 in our regional center. The two main causes of anemia were maternal red blood cell alloimmunization (N = 81, 87 %) and Parvovirus B19 infection (N = 10, 10.8 %). In the alloimmunization group, phototherapy was implemented in 85.2 % of cases with a maximum level of bilirubin of 114.4 ± 60.7 (mg/dl). Transfusion and exchange transfusion were, respectively, required in 51.9 % and in 34.6 % of cases. One neonate presented a convulsive episode, and we observed three neonatal deaths. In the parvovirus group, none of the child had anemia at birth and no management was necessary. CONCLUSION: Contemporary management of Rhesus disease is associated with encouraging neonatal outcomes. In case of Parvovirus infection, no specific management is necessary at. But, in all cases of fetal anemia, children should be followed up with particular attention to neurologic development. WHAT IS KNOWN: • In-utero transfusion is now well under control and improves the survival of fetuses monitored for fetal anemia. • Limited studies are available on the effect of IUT on postnatal outcome in infants with a history of fetal anemia. What is New: • Contemporary management of severe Rhesus disease is associated with encouraging neonatal outcomes. • The majority of infants can be managed with phototherapy and a limited number of top-up transfusions and exchange transfusions. In case of Parvovirus infection, the short-term neonatal outcome is excellent.
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