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Obstetrics & Gynecology 2007;109:42-47
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Long-Term Outcome After Fetal Transfusion for Hydrops Associated With Parvovirus B19 Infection

Hélène T. C. Nagel, MD1,3, Timo R. de Haan, MD2,4, Frank P. H. A. Vandenbussche, MD, PhD1, Dick Oepkes, MD, PhD1 and Frans J. Walther, MD, PhD2

From the 1Department of Obstetrics, Leiden University Medical Center, Leiden; 2Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden; 3Department of Obstetrics and Gynecology, Bronovo Hospital, the Hague; and 4Department of Pediatrics, Division of Neonatology, Academic Medical Center, University of Amsterdam, the Netherlands.

OBJECTIVE: To evaluate neurodevelopmental status of children treated with intrauterine red blood cell and platelet transfusion for fetal hydrops caused by parvovirus B19.

METHODS: Maternal and neonatal records of all intrauterine transfusions for congenital parvovirus B19 infection in our center between 1997 and 2005 were reviewed. Congenital B19 virus infection was confirmed by the presence of parvovirus B19–specific immunoglobulin M or parvovirus B19 DNA in fetal blood samples. All children underwent a general pediatric and neurological examination. Primary outcome measure was neurodevelopmental status (developmental index by Bayley Scales of Infant Development or Snijders-Oomen test). Secondary outcome measure was general health status of surviving children.

RESULTS: A total of 25 intrauterine transfusions were performed in 24 hydropic fetuses. Median fetal hemoglobin concentration, platelet count, and blood pH before intrauterine transfusions were 4.5 g/dL (range 2.4–11.4 g/dL), 79x109/L (range 37–238x109/L) and 7.36 (range 7.31–7.51), respectively. Sixteen survivors aged 6 months to 8 years were included in the follow-up study. Eleven children (68%) were normal, and 5 children (32%) demonstrated a delayed psychomotor development with an suboptimal neurological examination (mild delay n=3, severe delay n=2). Neurodevelopmental status did not correlate with pre-intrauterine transfusion hemoglobin, platelet, or blood pH values. Growth and general health status were normal in all. Two children had minor congenital defects.

CONCLUSION: Neurodevelopmental status was abnormal in 5 of 16 survivors and was not related to the severity of fetal anemia and acidemia. We hypothesize that fetal parvovirus B19 infection may induce central nervous system damage.

LEVEL OF EVIDENCE: III






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