Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience

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.

Hidrops Fetalis Sýklýðý ve Prognozu: 10 YýllýkTek Merkez Deneyimi

Amaç: Hidrops fetalis (HF) tanýsý ile yatýrýlarak tedavi edilen yenidoðan bebeklerin etiyolojik daðýlým ve prognozunun deðerlendirilmesi
Yöntem: Bu retrospektif tanýmlayýcý çalýþmaya, hastanemizde son on yýllýk süre içerisinde doðan ve HF tanýsý ile yatýrýlan tüm infantlar çalýþmaya alýndý. Bebeklerin demografik özellikleri, saptanan etiyolojik daðýlýmlar ile uygulanan tedavi giriþimleri ve prognoz bilgileri geriye yönelik olarak kaydedildi. Bebek verileri tam olmayan infantlar çalýþma dýþý býrakýldý
Bulgular: Çalýþmaya alýnan 21 HF tanýlý olgunun ortalama gestasyonel yaþý 33,6±3,1 hafta, ortalama doðum aðýrlýðý 2444±792 gram idi. HF olgularýnýn %90,5’i sezeryan ile doðmuþtu ve prenatal taný oraný %42,9 idi. Doðum salonunda, doðumda canlandýrma uygulanan bebeklerin %57.1’i entübe edilmiþti. Yenidoðan Yoðun Bakým Ünitesi’nde %81 olgu entübe edilmiþ ve %71,4’ü surfaktan tedavisi almýþtý. HF bulgularýndan en sýk asit (%81) ve cilt altý ödem (%81) saptandý. Olgulara en sýk giriþimsel iþlem olarak parasentez (%81) ve torasentez (%52,4) uygulanmýþtý. Ýmmun HF nedeni ile 2 olguya (%9,5) kan deðiþimi uygulanmýþtý. Çalýþma grubunda mortalite %52,4 idi. Çalýþma grubunda HF olgularýnýn etyolojik daðýlým deðerlendirildiðinde, 3 olguda (%14,3) immun HF ve 18 olguda (%85,7) non-immun hidrops fetalis (NIHF) saptandý. Ýmmun HF olgularýnda altta yatan neden rhesus (Rh) uyuþmazlýðý idi. NIHF saptanan olgularda, etyolojide en sýk idiyopatik (%23.8) ve kardiovasküler hastalýk (19,04%) saptandý. Doðum salonu uygulamalarý ile mortalite arasýnda anlamlý iliþki saptandý. Kaybedilen olgularda doðumhanede entübasyon gereksinimi anlamlý yüksek iken yaþayanlarda doðumhanede sadece pozitif basýnçlý ventilasyon uygulanma sýklýðý anlamlý yüksek idi ( p sýrasýyla; 0,017 ve0,013). Ýmmun HF olgularýnda saðkalým %66,7, NIHF olgularýnda saðkalým %44,4 idi.
Sonuç: Hidrops fetalis tanýlý bebeklerde perinatal mortalite riski altta yatan nedene baðlý olarak yüksektir. Çalýþmamýzda HF’in büyük bir oranda non immün nedenler ile geliþtiði, prenatal taný ve izlemin bu bebeklerde yetersiz olduðu ve doðumhanede uygulanan giriþimlerin HF’li yenidoðan bebeklerde mortaliteyi öngörmede etkili bir faktör olduðu saptandý. (SETB-2021-06-189)