Hudon L, Moise K J, Hegemier S E, Hill R M, Moise A A, Smith E O, Carpenter R J
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Obstet Gynecol. 1998 Oct;179(4):858-63. doi: 10.1016/s0002-9378(98)70178-4.
The aim of the study was to assess the developmental outcome of neonatal survivors of hemolytic disease of the neonate treated with modern intrauterine transfusion techniques.
In this prospective, observational study, auditory evoked-response tests were performed in the nursery. Neurodevelopmental evaluation with the Gesell Developmental Schedules was performed between 9 and 18 months of corrected age to assess motor skills, language development, comprehension capacity, and social skills. The McCarthy Scales of Children's Abilities were administered between 36 and 62 months.
Forty children who survived severe fetal hemolytic disease were followed up until 62 months old. Demographic data included gestational age at first intrauterine transfusion (26.4 +/- 3.7 weeks), median number of intrauterine transfusions (4, range 1-8), lowest fetal hematocrit (20.2% +/- 7.8%), peak fetal bilirubin (7.1 +/- 2.1 mg/dL), incidence of hydrops fetalis (45%), and mean gestational age at delivery (35.6 +/- 2.2 weeks). One case of severe bilateral deafness and 1 case of right spastic hemiplegia were diagnosed. The Gesell Developmental Schedules score was assessed between 9 and 18 months of corrected age in 22 infants. The global developmental quotient was 101.9 +/- 9.5 (mean for normal population is 100). Regression analysis revealed no correlation between the global developmental quotient and gestational age at the first intrauterine transfusion, gestational age at birth, or the severity of the fetal hemolytic disease (fetal hematocrit, fetal bilirubin, presence of hydrops fetalis, total number of intrauterine transfusions, duration of neonatal phototherapy, and number of neonatal exchange transfusions). Eleven of the 40 children were followed up until they were 62 months old, and the McCarthy Scales of Children's Abilities were administered. The mean cognitive index was 107.6 +/- 9.4 (90-109 is considered average).
Despite severe fetal hemolytic disease, normal developmental outcome can be expected for children treated with intrauterine transfusions.
本研究旨在评估采用现代宫内输血技术治疗的新生儿溶血病存活者的发育结局。
在这项前瞻性观察研究中，在新生儿重症监护室进行听觉诱发电位测试。在矫正年龄9至18个月之间，采用格塞尔发育量表进行神经发育评估，以评估运动技能、语言发育、理解能力和社交技能。在36至62个月之间使用麦卡锡儿童能力量表进行测试。
40名患有严重胎儿溶血病的存活儿童被随访至62个月龄。人口统计学数据包括首次宫内输血时的胎龄（26.4±3.7周）、宫内输血的中位数（4次，范围1 - 8次）、最低胎儿血细胞比容（20.2%±7.8%）、最高胎儿胆红素（7.1±2.1mg/dL）、胎儿水肿的发生率（45%）以及分娩时的平均胎龄（35.6±2.2周）。诊断出1例严重双侧耳聋和1例右痉挛性偏瘫。在22例婴儿矫正年龄9至18个月之间评估格塞尔发育量表评分。总体发育商为101.9±9.5（正常人群平均值为100）。回归分析显示，总体发育商与首次宫内输血时的胎龄、出生时的胎龄或胎儿溶血病的严重程度（胎儿血细胞比容、胎儿胆红素、胎儿水肿的存在、宫内输血的总数、新生儿光疗持续时间以及新生儿换血输血次数）之间无相关性。40名儿童中有11名被随访至62个月龄，并进行了麦卡锡儿童能力量表测试。平均认知指数为107.6±9.4（90 - 109被认为是平均水平）。
尽管患有严重胎儿溶血病，但接受宫内输血治疗的儿童有望获得正常的发育结局。
