Cerebral injury and long-term neurodevelopment impairment in children following severe fetomaternal transfusion: a retrospective cohort study.

IF 3.9 2区 医学 Q1 PEDIATRICS
Salma El Emrani, Marie-Louise van der Hoorn, Ratna N G B Tan, Sylke J Steggerda, Linda S de Vries, Monique C Haak, Jeanine M M van Klink, Masja de Haas, Lotte E van der Meeren, Enrico Lopriore
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引用次数: 0

Abstract

Objective: Fetomaternal transfusion (FMT) is associated with increased perinatal mortality and morbidity, but data on postnatal outcomes are scarce. Our aim was to determine the incidence of adverse short-termand long-term sequelae of severe FMT.

Design: Retrospective cohort study.

Setting: Dutch tertiary neonatal intensive care unit.

Patients: Liveborn neonates with FMT admitted in 2017-2022.

Main outcome measures: Severe FMT was defined as ≥30 mL of fetal red blood cells in the maternal circulation diagnosed with positive Kleihauer-Betke/flow cytometry test. Adverse outcomes were compared between severe and mild FMT (10-30 mL blood loss) to highlight the impact of FMT severity. Primary outcome was an adverse composite outcome consisting of neonatal mortality or severe neurological morbidity (ie, severe cerebral injury and/or neurodevelopmental impairment (NDI) at 2 years). Secondary outcome was perinatal asphyxia.

Results: 109 neonates with FMT were included, 16 with severe FMT and 93 with mild FMT. Neonatal mortality occurred in 19% (3/16) of neonates with severe FMT and in 4% (4/93) with mild FMT (p=0.063). Perinatal asphyxia was diagnosed in 25% (4/16) of neonates with severe FMT compared with 6% (6/93) with mild FMT (p=0.038). Long-term outcome was assessed in 60 neonates. NDI occurred in 22% (2/9) of children with severe FMT compared with 16% (8/51) with mild FMT (p=0.637). Adverse outcome occurred in 43% (95% CI 38 to 50%) of neonates with severe FMT compared with 18% (95% CI 17% to 24%) with mild FMT (p=0.074).

Conclusion: Neonatal mortality or long-term neurological morbidity occurred in 38%-50% of children with fetal blood loss and anaemia due to severe FMT.

严重母婴输血后儿童脑损伤和长期神经发育障碍:一项回顾性队列研究
目的:胎母输血(FMT)与围产期死亡率和发病率增加有关,但有关产后结局的数据很少。我们的目的是确定严重FMT的不良短期和长期后遗症的发生率。设计:回顾性队列研究。环境:荷兰三级新生儿重症监护病房。患者:2017-2022年住院的FMT活产新生儿。主要观察指标:重度FMT定义为经Kleihauer-Betke/流式细胞术检测阳性的母体循环中胎儿红细胞≥30 mL。比较严重和轻度FMT (10- 30ml失血)的不良结局,以突出FMT严重程度的影响。主要转归是由新生儿死亡率或严重神经系统疾病(即2岁时严重脑损伤和/或神经发育障碍(NDI))组成的不良综合转归。次要结局为围产期窒息。结果:109例新生儿FMT,其中重度FMT 16例,轻度FMT 93例。重度FMT患儿死亡率为19%(3/16),轻度FMT患儿死亡率为4% (4/93)(p=0.063)。重度FMT患儿围生期窒息发生率为25%(4/16),轻度FMT患儿为6% (6/93)(p=0.038)。对60名新生儿的长期预后进行了评估。重度FMT患儿的NDI发生率为22%(2/9),而轻度FMT患儿的NDI发生率为16% (8/51)(p=0.637)。重度FMT新生儿的不良结局发生率为43% (95% CI 38 ~ 50%),轻度FMT为18% (95% CI 17% ~ 24%) (p=0.074)。结论:严重FMT所致胎儿失血和贫血患儿的新生儿死亡率或长期神经系统疾病发生率为38%-50%。
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来源期刊
CiteScore
9.00
自引率
4.50%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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