Paediatrics: Hydrops foetalis

Hydrops foetalis

Abnormal accumulation of fluid in skin and body compartments. Results from rate of production of interstitial fluid exceeding absorption.

Characterized in the foetus by:

·  Gross generalized oedema;

·  Ascites;

·  Pleural ± pericardial effusions.

If still present at birth, it results in severe illness. Incidence 71/2500 to 1/4000 births.

Causes

Hydrops is due to underlying disease, singularly or in combination result-ing in: rise capillary hydrostatic pressure; fall colloid osmotic pressure; lym-phatic obstruction; capillary leaking.

Associated complications

·  Intrauterine/perinatal death.

·  Obstetric complications, e.g. shoulder dystocia.

·  Preterm labour.

·  Pulmonary hypoplasia (pleural effusions).

·  Perinatal asphyxia.

Management

Disorders treatable antenatally

·  Intrauterine blood transfusion (IUT) for haemolytic disease/ parvovirus infection

·  Anti-arrhythmia drugs to treat foetal SVT

·  Laser ablation of foetal vessels (twin-twin transfusion syndrome)

Birth planning

Before birth organize expert help

·  If anaemia likely, have available fresh CMV –ve, O –ve blood, irradiated (if previous IUT), cross-matched blood against the mother

·  Prepare for full resuscitation, ventilation, UVC insertion, paracentesis (ascites), or pleural effusion drainage

Neonatal management

Resuscitation:

·  ventilation, intubation

·  paracentesis, thoracentesis

·  blood transfusion or partial exchange transfusion

Supportive management:

·  cardiac support—pressors, ionotropes

·  respiratory support—mechanical ventilation

·  chest tube placement, drainage of ascites

·  fluid and electrolyte management

·  treatment of anemia: blood transfusion or partial exchange

·  transfusion

·  treatment of infections

·  octreotide to treat chylothorax and ascites

Prognosis

For foetuses or infants with non-immune hydrops, the survival rates are variable, in the range of 50%. Higher survival is reported in infants with SVT, chylothorax, and parvovirus infections, and lower rates in those with chromosomal abnormalities. Survival rates with immune hydrops is > 80%. Neurodevelopmental outcome depends on cause.