Abstract
Background: In-utero transfusion (IUT) has transformed the management and outcome of severe Rhesus disease.
Objective: To assess the outcomes of babies that had IUT in a tertiary Fetal Medicine and red cell alloimmunization Centre.
Methods: Retrospective analysis of all cases of IUT for severe Rhesus disease over a 10 year period.
Results: 263 IUT were performed in 80 pregnancies. Median IUT was 3 (range 1-8). Antibodies involved were: anti-D (84%); anti-Kell (13%) and anti-c (3%). 19 (24%) cases were hydropic: of these 3 were intra-uterine deaths, 2 neonatal deaths and 3 were born elsewhere. 74 were live births (92.5%); median gestation 34 weeks (range 24-38), 11 babies ≤30 weeks, 5 born elsewhere. Of the 69 infants born in our centre, 3 died in the neonatal period and 1 infant at 19 months (SIDS). Median cord haemoglobin was 10.7g/dL (range 5.7-20.9). 29/69 (42%) babies required 45 exchange transfusions (range 1-5). 57/69 (83%) babies required 151 top-up blood transfusions (median 2, range 1-20). Of those ≤30 weeks, 9/11 survived (82%), 2 had retinopathy of prematurity and 3 had cranial ultrasound abnormalities. At 2 years, 7/9 babies were normal and 2 had developmental delay. 53/56 (95%) surviving babies >30 weeks had normal neurodevelopment at 1 year except one with sensori-neural deafness.
Conclusion: IUT is safe and does not appear to increase postnatal morbidity. In our experience, it has reduced the need for postnatal exchange transfusions. However, top-up transfusions are more likely.
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Chandra, P., Rasiah, S., Ewer, A. et al. 1202 Outcomes of Babies with Severe Rhesus Disease Following In-Utero Transfusions - a 10 Year Experience. Pediatr Res 68 (Suppl 1), 594–595 (2010). https://doi.org/10.1203/00006450-201011001-01202
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DOI: https://doi.org/10.1203/00006450-201011001-01202