Unal Ebru Turkoglu, Bulbul Ali, Bas Evrim Kiray, Uslu Hasan Sinan
Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2021 Sep 24;55(3):366-373. doi: 10.14744/SEMB.2021.65632. eCollection 2021.
The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF).
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.
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.
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.
本研究旨在评估胎儿水肿（HF）新生儿的病因分布及预后。
本回顾性描述性研究纳入了我院过去10年内出生且诊断为HF并住院治疗的所有婴儿。回顾性记录婴儿的人口统计学特征、病因分布、治疗干预措施及预后信息。数据不完整的婴儿被排除在研究之外。
HF婴儿的平均胎龄为33.6±3.1周，平均出生体重为2444±792克。在HF病例中，90.5%通过剖宫产出生，产前诊断率为42.9%。约57.1%的婴儿在产房出生复苏时需要插管。在新生儿重症监护病房（NICU），81%的病例需要插管，71.4%接受了表面活性剂治疗。最常见的HF表现是腹水（81%）和皮下水肿（81%）。最常见的干预操作是腹腔穿刺术（81%）和胸腔穿刺术（52.4%）。由于免疫性HF，2例（9.5%）进行了换血治疗。研究组的死亡率为52.4%。考虑到研究组HF病例的病因分布，3例被诊断为免疫性HF（14.3%），18例为非免疫性胎儿水肿（NIHF）（85.7%）。免疫性HF病例的根本原因是恒河猴血型不相容。在NIHF病例中，特发性（23.8%）和心血管疾病是最常见的病因。发现产房管理与死亡率之间存在显著关系。非幸存者在产房需要插管的比例显著更高，而幸存者在产房仅应用正压通气的频率显著更高。免疫性HF病例的存活率为66.7%，而NIHF病例为44.4%。
HF婴儿围产期死亡风险因潜在病因而异。本研究确定，HF大多由非免疫原因引起，产前诊断和随访不足，产房实施的干预措施是预测HF新生儿随访死亡率的重要因素。
