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Ergani SY, İbanoğlu MC, Çakır A, Ateş Ç, Örgül G, Tonyalı NV, Çelik ÖY, Şahin D. Etiology and perinatal outcomes between early and late-onset nonimmune hydrops fetalis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231723. [PMID: 39045931 PMCID: PMC11262323 DOI: 10.1590/1806-9282.20231723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/30/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE We aimed to compare the etiology and perinatal outcomes of non-immune hydrops fetalis diagnosed early- and late-onset at our hospital. METHODS The records of the patients who applied to our department were reviewed, and we reached 42 non-immune hydrops fetalis cases retrospectively and examined the medical records. Hydrops diagnosis week, birth week, accompanying anomalies, and perinatal outcomes were compared as ≤12 weeks (early-onset) and >12 weeks (late-onset). RESULTS The prevalence of non-immune hydrops fetalis was 0.05%, and the median week of diagnosis for hydrops was 18 weeks. Consanguinity (16.7%) was found in seven pregnancies, and the other seven patients (16.7%) had a history of hydrops in previous pregnancies. Anomalies of the skeletal system, central nervous system, and gastrointestinal tract accounted for 66.7% of ≤12 weeks in non-immune hydrops fetalis cases. Cardiac abnormalities were more common (26.7%) in patients at > 12 weeks (p=0.078). A statistically significant difference was found between the distribution of week of birth and week of diagnosis (p=0.029). Notably, 66.7% of patients diagnosed before week 12 and 23.3% of patients diagnosed after week 12 delivered their babies before week 24. Spontaneous intrauterine death occurred before week 12 in 45.5% (n=5) of non-immune hydrops fetalis and after week 12 in 39.1% (n=9) of non-immune hydrops fetalis. Notably, 69.2% (n=9) of the patients who had prenatal invasive testing resulted in normal karyotype. CONCLUSION In this study, most of the fetuses diagnosed with early-onset non-immune hydrops fetalis were born in the first 24 weeks. Additionally, live birth rates and cardiac anomalies were observed to be higher in late-onset non-immune hydrops fetalis.
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Affiliation(s)
- Seval Yılmaz Ergani
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Perinatology – Ankara, Turkey
| | - Müjde Can İbanoğlu
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Ayberk Çakır
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Çağlayan Ateş
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Gökcen Örgül
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Perinatology – Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Perinatology – Ankara, Turkey
| | - Özge Yücel Çelik
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Perinatology – Ankara, Turkey
| | - Dilek Şahin
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Perinatology – Ankara, Turkey
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2
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Smeland MF, Brouillard P, Prescott T, Boon LM, Hvingel B, Nordbakken CV, Nystad M, Holla ØL, Vikkula M. Biallelic ANGPT2 loss-of-function causes severe early-onset non-immune hydrops fetalis. J Med Genet 2023; 60:57-64. [PMID: 34876502 PMCID: PMC9811075 DOI: 10.1136/jmedgenet-2021-108179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hydrops fetalis, a pathological fluid accumulation in two or more body compartments, is aetiologically heterogeneous. We investigated a consanguineous family with recurrent pregnancy loss due to severe early-onset non-immune hydrops fetalis. METHODS AND RESULTS Whole exome sequencing in four fetuses with hydrops fetalis revealed that they were homozygous for the angiopoietin-2 (ANGPT2) variant Chr8 (GRCh37/Hg19): 6385085T>C, NM_001147.2:c.557A>G. The substitution introduces a cryptic, exonic splice site predicted to result in loss of 10 nucleotides with subsequent shift in reading frame, leading to a premature stop codon. RNA analysis in the heterozygous parents demonstrated loss of detectable mutant allele, indicative of loss-of-function via nonsense-mediated mRNA decay. Serum ANGPT2 levels were reduced in the parents. In a pregnancy with a healthy, heterozygous child, transiently increased fetal nuchal translucency was noted. CONCLUSION Pathogenic heterozygous ANGPT2 missense variants were recently shown to cause autosomal dominant primary lymphoedema. ANGPT2 is a ligand of the TIE1-TIE2 (tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 1 and 2) pathway. It is critical to the formation and remodelling of blood and lymphatic vessels and is involved in vessel maintenance. ANGPT2 knockout mice die from generalised lymphatic dysfunction. We show here that a homozygous pathogenic variant causes loss-of-function and results in severe early-onset hydrops fetalis. This is the first report of an autosomal recessive ANGPT2-related disorder in humans.
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Affiliation(s)
- Marie F. Smeland
- Department of Medical Genetics, University Hospital of North Norway, Tromsø, Norway
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, Universite catholique de Louvain, Brussels, Belgium
| | - Trine Prescott
- Department of Medical Genetics, Telemark Hospital, Skien, Norway
| | - Laurence M Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, University Hospital Saint-Luc, Bruxelles, Belgium
| | - Bodil Hvingel
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Cecilie V Nordbakken
- Department of Clinical Pathology, University Hospital of North Norway, Tromsø, Norway
| | - Mona Nystad
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway,Department of Clinical Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Øystein L. Holla
- Department of Medical Genetics, Telemark Hospital, Skien, Norway
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Universite catholique de Louvain, Brussels, Belgium,Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, University Hospital Saint-Luc, Bruxelles, Belgium
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3
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Pina Moreno J, Ortega Abad V, Perez Corral A, Garcia‐Tizon Larroca S. Maternal mirror syndrome with foetal hydrops due to isoimunization by anti-KPa antibodies: A case report and narrative literature review. Clin Case Rep 2022; 10:e05484. [PMID: 35223025 PMCID: PMC8850394 DOI: 10.1002/ccr3.5484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/11/2022] [Indexed: 11/12/2022] Open
Abstract
We present a rare case of mirror syndrome due to anti-Kpa antibodies, which can be difficult to identify with routine screening tests.
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Affiliation(s)
| | | | - Ana Perez Corral
- HematologyHospital General Universitario Gregorio MarañonMadridSpain
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4
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Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:366-373. [PMID: 34712079 PMCID: PMC8526230 DOI: 10.14744/semb.2021.65632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
Objective: The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF). Methods: All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study. Results: The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases. Conclusion: The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.
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5
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Hasija VK, Mirza A, Khowaja WH, Asif S, Salat MS, Ariff S, Ahmad K. Clinical Profile and Predictors of Mortality in Neonates Born With Non-Immune Hydrops Fetalis: Experience From a Lower-Middle-Income Country. Cureus 2021; 13:e17830. [PMID: 34660039 PMCID: PMC8500813 DOI: 10.7759/cureus.17830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Hydrops fetalis (HF) is a life-threatening condition in which a fetus has an abnormal collection of fluid in the tissue around the lungs, heart, abdomen, or under the skin. Based on its pathophysiology, it is classified into immune and non-immune types. With the widespread use of anti-D immunoglobulin, non-immune HF has become more common, with an incidence of one in 1,700-3,000 live births. A multitude of fetal diseases with various causes can lead to non-immune HF. Due to the recent advances in prenatal diagnostic and therapeutic interventions together with improved neonatal intensive care, the diagnosis and subsequent management of HF have been refined. However, HF is still associated with a high mortality rate. A recent assessment of the literature found that there is a lack of data on prognostic variables in neonates with HF from low- and middle-income countries. In light of this, we sought to establish the etiologic causes, predictors of mortality, and eventual fate of newborns born non-immune HF at the Aga Khan University Hospital, Karachi during the 10-year period spanning January 2009-December 2019 in this retrospective analysis. Methodology For this study, we collected data from the computerized database and patient record files at the hospital on all infants with non-immune HF. Demographic data, postnatal interventions, clinical and laboratory findings, outcomes, and the results of comparison between HF patients who died and those who survived were analyzed. Results The incidence of non-immune HF at our hospital was 0.62/1,000 live births during the period under study, with 33 newborn babies diagnosed with non-immune HF from a total of 53,033 live-born deliveries. An etiologic factor was discovered in 17 (51.5%) neonates with non-immune HF while 16 (48.4%) were classified as those with unidentified etiology. The most common causes were cardiovascular and genetic syndromes, which resulted in 100% mortality. The overall mortality rate was 67%. The need for mechanical ventilation, surfactant therapy, and prolonged hospitalization were identified as independent risk factors of mortality. Conclusion Our study proves that the need for mechanical ventilation [moderate to severe hypoxic respiratory failure (HRF)] and prolonged hospitalization are strong predictors of poor outcomes in neonates with non-immune HF. Therefore, severe hydrops causing significant mortality can be anticipated based on the patients' respiratory status and the need for escalated oxygen support.
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Affiliation(s)
- Vinod K Hasija
- Pediatrics-Neonatal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Adnan Mirza
- Pediatrics-Neonatal Medicine, Limerick University Maternity Hospital, Limerick, IRL.,Neonatal Fellowship Program/Neonatal Intensive Care Unit, Aga Khan University Hospital, Karachi, PAK
| | - Waqar H Khowaja
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Sidra Asif
- Pediatrics, Aga Khan University Hospital, Karachi, PAK
| | | | - Shabina Ariff
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Khalil Ahmad
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
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6
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Whybra C, Källén K, Hansson SR, Gunnarsson R. Non-immune hydrops fetalis was rare in Sweden during 1997-2015, but cases were associated with complications and poor prognosis. Acta Paediatr 2020; 109:2570-2577. [PMID: 32187745 DOI: 10.1111/apa.15260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
AIM The study was designed to document the incidence of non-immune hydrops fetalis (NIHF) at birth and characterise associated outcomes and obstetric complications. METHODS Data on more than 1.9 million births were extracted from the Swedish Birth Register for 1997-2015. Pregnancies not affected by NIHF served as controls. National registers on mortality and hospitalisations provided follow-up information. RESULTS There were 309 cases of NIHF at birth corresponding to an incidence of 1.6 per 10 000, lower than in previous studies. NIHF was more frequent in mothers aged ≥35 years and with a history of stillbirth. Preterm delivery occurred in 77.7% in the NIHF group, including 31.7% before 32 weeks of gestation. Multiple births and Caesarean sections were reported more frequent in the NIHF group. NIHF was associated with poor outcome with 14.6% stillbirths and in 26.5% early neonatal death. Overall, 58.7% of live-born children with NIHF were alive at 12 months compared with 99.7% of controls. The most common causes of death were cardiovascular diseases and thoracic abnormalities. CONCLUSION NIHF at birth is associated with obstetric complications and poor prognosis for the neonate related to underlying disease. The low incidence of NIHF observed in this study may reflect well-developed antenatal care.
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Affiliation(s)
- Catharina Whybra
- Department of Neonatology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Karin Källén
- Department of Obstetrics and Gynecology Clinical Sciences Lund Lund University Lund Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology Clinical Sciences Lund Lund University Lund Sweden
| | - Rolf Gunnarsson
- Department of Obstetrics and Gynecology Clinical Sciences Lund Lund University Lund Sweden
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7
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Gilby DM, Mee JB, Kamlin COF, Kornman LH, Davis PG, Manley BJ. Outcomes following antenatal identification of hydrops fetalis: a single-centre experience from 2001 to 2012. Arch Dis Child Fetal Neonatal Ed 2019; 104:F253-F258. [PMID: 29769237 DOI: 10.1136/archdischild-2017-313604] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 04/05/2018] [Accepted: 05/03/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the aetiologies and outcomes of pregnancies complicated by hydrops fetalis (HF). STUDY DESIGN Case series of all pregnancies complicated by HF managed at The Royal Women's Hospital (RWH), Melbourne, Australia, between 2001 and 2012. Multiple pregnancies, and cases where antenatal care was not provided at RWH were excluded. Cases were identified from neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, electronic pathology and radiology reports, and obstetric and neonatal databases. RESULTS Over 12 years, 131 fetuses with HF with a median (IQR) gestational age (GA) at diagnosis of 24 (20-30) weeks were included in the analysis. There were 65 liveborn infants with a median (IQR) GA at birth of 33 (31-37) weeks and a median (IQR) birthweight Z-score of 1.4 (0.4-2.2). Overall survival from diagnosis was 27% (36/131) increasing to 55% (36/65) if born alive. CONCLUSIONS The perinatal mortality risk for fetuses and newborn infants with HF is high with important differences dependent on underlying diagnosis and the time at which counselling is provided. Clinicians need to be aware of the outcomes of both fetuses and neonates with this condition.
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Affiliation(s)
- Damien M Gilby
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia
| | - J Bridie Mee
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia
| | - C Omar Farouk Kamlin
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Louise H Kornman
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brett James Manley
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Laterre M, Bernard P, Vikkula M, Sznajer Y. Improved diagnosis in nonimmune hydrops fetalis using a standardized algorithm. Prenat Diagn 2018; 38:337-343. [DOI: 10.1002/pd.5243] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Marie Laterre
- Centre for Human Genetics; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Obstetrics Department; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
| | - Pierre Bernard
- Obstetrics Department; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
| | - Miika Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Center for Vascular Anomalies; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Walloon Excellence in Life Sciences and Biotechnology (WELBIO); de Duve Institute, UCL.; Brussels Belgium
| | - Yves Sznajer
- Centre for Human Genetics; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
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9
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Thoracoamniotic shunting for fetal pleural effusion with hydropic change using a double-basket catheter: An insight into the preoperative determinants of shunting efficacy. Eur J Obstet Gynecol Reprod Biol 2018; 221:34-39. [DOI: 10.1016/j.ejogrb.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/20/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
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10
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Steurer MA, Peyvandi S, Baer RJ, MacKenzie T, Li BC, Norton ME, Jelliffe-Pawlowski LL, Moon-Grady AJ. Epidemiology of Live Born Infants with Nonimmune Hydrops Fetalis-Insights from a Population-Based Dataset. J Pediatr 2017; 187:182-188.e3. [PMID: 28533037 DOI: 10.1016/j.jpeds.2017.04.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/24/2017] [Accepted: 04/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the incidence, etiology, and 1-year mortality of nonimmune hydrops fetalis (NIHF) and to identify risk factors for mortality in a contemporary population-based dataset. STUDY DESIGN The California Office of Statewide Health Planning and Development maintains a database linking maternal and infant hospital discharge, readmissions, and birth and death certificate date from 1 year before to 1 year after birth. We searched the database (2005-2012) for infants with NIHF (identified by the International Classification of Diseases, 9th Revision, Clinical Modification code). Hazard models were used to identify risk factors for mortality in infants with NIHF; results are presented as hazard ratios (HRs, 95% CI). RESULTS The incidence of NIHF was 2.5 out of 10 000 among live born infants. Neonatal mortality was 35.1% (364 out of 1037) and overall mortality was 43.2% (448 out of 1037) at 1 year of age. Gestational age (GA) was predictive of mortality with a HR of 2.4 (95% CI 1.9-3.2) for preterm compared with term infants. The GA-adjusted HR for mortality was 1.3 (95% CI 1.1-1.6) for polyhydramnios and 1.5 (95% CI 1.2-2.0) for large for gestational age infants compared with appropriate for GA infants. Aneuploid infants with critical congenital heart disease had an adjusted HR of 2.3 (95% CI 1.5-3.6) compared with euploid infants without a structural birth defect. CONCLUSIONS In this large, population-based study, prematurity, polyhydramnios, and large for gestational age were predictors of increased mortality. Mortality is highly variable among euploid and aneuploid infants with and without structural birth defects and critical congenital heart disease.
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Affiliation(s)
- Martina A Steurer
- Department of Pediatrics, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Shabnam Peyvandi
- Department of Pediatrics, University of California, San Francisco, CA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, CA
| | - Tippi MacKenzie
- Department of Pediatric Surgery, University of California San Francisco, San Francisco, CA
| | - Ben C Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
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11
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Confirmation of etiology in fetal hydrops by sonographic evaluation of fluid allocation patterns. Eur J Obstet Gynecol Reprod Biol 2015; 195:128-132. [DOI: 10.1016/j.ejogrb.2015.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 08/16/2015] [Accepted: 09/03/2015] [Indexed: 11/13/2022]
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12
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Bellini C, Donarini G, Paladini D, Calevo MG, Bellini T, Ramenghi LA, Hennekam RC. Etiology of non-immune hydrops fetalis: An update. Am J Med Genet A 2015; 167A:1082-8. [DOI: 10.1002/ajmg.a.36988] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/28/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Carlo Bellini
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Gloria Donarini
- Fetal Medicine and Surgery Unit; Gaslini Institute; Genoa Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit; Gaslini Institute; Genoa Italy
| | - Maria Grazia Calevo
- Department of Epidemiology; Biostatistics and Committees; Gaslini Institute; Genoa Italy
| | - Tommaso Bellini
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Luca A Ramenghi
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Raoul C Hennekam
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
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13
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Norton ME, Chauhan SP, Dashe JS, Dashe JS. Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis. Am J Obstet Gynecol 2015; 212:127-39. [PMID: 25557883 DOI: 10.1016/j.ajog.2014.12.018] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/12/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red cell alloimmunization. The most common etiologies include cardiovascular, chromosomal, and hematologic abnormalities, followed by structural fetal anomalies, complications of monochorionic twinning, infection, and placental abnormalities. We sought to provide evidence-based guidelines for the evaluation and management of nonimmune hydrops fetalis. METHODS A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library. The search was restricted to English-language articles published from 1966 through June 2014. Priority was given to articles reporting original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institutes of Health, Agency for Health Research and Quality, American Congress of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grading of Recommendations Assessment, Development, and Evaluation methodology was employed for defining strength of recommendations and rating quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS Evaluation of hydrops begins with an antibody screen (indirect Coombs test) to determine if it is nonimmune, detailed sonography of the fetus(es) and placenta, including echocardiography and assessment for fetal arrhythmia, and middle cerebral artery Doppler evaluation for anemia, as well as fetal karyotype and/or chromosomal microarray analysis, regardless of whether a structural fetal anomaly is identified. Recommended treatment depends on the underlying etiology and gestational age; preterm delivery is recommended only for obstetric indications including development of mirror syndrome. Candidates for corticosteroids and antepartum surveillance include those with an idiopathic etiology, an etiology amenable to prenatal or postnatal treatment, and those in whom intervention is planned if fetal deterioration occurs. Such pregnancies should be delivered at a facility with the capability to stabilize and treat critically ill newborns. The prognosis depends on etiology, response to therapy if treatable, and the gestational age at detection and delivery. Aneuploidy confers a poor prognosis, and even in the absence of aneuploidy, neonatal survival is often <50%. Mirror syndrome is a form of severe preeclampsia that may develop in association with fetal hydrops and in most cases necessitates delivery.
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Affiliation(s)
| | | | | | - Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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14
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Etiology and outcome of hydrops fetalis: report of 62 cases. Pediatr Neonatol 2014; 55:108-13. [PMID: 24094760 DOI: 10.1016/j.pedneo.2013.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/11/2013] [Accepted: 07/03/2013] [Indexed: 01/30/2023] Open
Abstract
AIM We aimed to define the etiologic and prognostic factors in live-born infants with hydrops fetalis (HF) in our tertiary neonatal intensive care unit over a 10-year period. METHODS Medical records of newborn infants with HF during 2002-2011 were reviewed retrospectively. Demographic data, prenatal interventions, clinical and laboratory findings, outcomes, and the results of postmortem examinations were analyzed. RESULTS During the study period, 62 newborn infants with HF were identified from 16,200 live-born deliveries and the incidence of HF was 3.8/1000 live births in our hospital. Twenty-eight infants (45.2%) had immune HF, whereas 34 (54.8%) had nonimmune HF. An etiologic factor could be identified in 24 (70.5%) infants with nonimmune HF. Lymphatic dysplasias comprised the majority (23.5%) of the infants with nonimmune HF. Mortality rate was 50%. The presence of two or more serous cavity effusions and gestational age were independently associated with the risk of mortality. CONCLUSION Despite the improvements in neonatal care, mortality rate in infants with HF is still high. Gestational age and the extent of serous cavity determine the risk of mortality. Timely and advanced prenatal or postnatal new therapeutic strategies may alter this fatal outcome in appropriate patients.
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Hasnani-Samnani Z, Mahmoud MIM, Farid I, Al Naggar E, Ahmed B. Non-immune hydrops: Qatar experience. J Matern Fetal Neonatal Med 2012; 26:449-53. [DOI: 10.3109/14767058.2012.733781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Erdemoğlu M, Kuyumcuoglu U, Guzel A, Celik Y, Kale E. Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study. Braz J Med Biol Res 2011; 44:725-8. [DOI: 10.1590/s0100-879x2011007500076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/06/2011] [Indexed: 11/22/2022] Open
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