Anemia of Prematurity - Portal Neonatal

accumulations and/or hydramnios), or to therapeutic interventions (fetal thoracentesis,
paracentesis, and/or complex fetal surgical procedures). Generally, the earlier in gestation that fetal
hydrops is recognized, the poorer the prognosis.
Race: Ethnic influences are related almost entirely to cause. Selected examples include the
importance of genetic variations in the alpha-chain structure of hemoglobin in Asian and
Mediterranean populations in addition to the more serious nature of the hemolytic disease in the
African American fetus affected by maternal ABO-factor isoimmunization.
Sex: Sex influences in incidence or outcome of hydrops fetalis are related largely to the cause of
the condition. A significant proportion of hydrops is caused by or associated with chromosomal
abnormalities or syndromes. Many of these are X-linked disorders.
Since most individuals with hydrops fetalis are delivered quite prematurely, and since fetal
pulmonary maturation takes place earlier in female than in male fetuses, male preterm infants are
at greater risk for the pulmonary complications of very preterm delivery. They are also at greater
risk for infections (nosocomial or otherwise), which are so common in the very preterm infant. A
striking example of greater male risk is the nearly 13-fold increase in the odds ratio for development
of hydrops in the male fetus with Rh D hemolytic disease. While a single precise risk figure is not
available for the heterogenous collection of cases that comprise hydrops fetalis, saying that the
male fetus is at greater risk for occurrence, morbidity, and mortality appears to be safe.
CLINICAL Section 3 of 10
History: A history suggesting the presence of any of the following factors should trigger an
extensive diagnostic study:
• Maternal history
o Rh negative (d;d) blood type
o Known presence of isoimmune blood group antibodies
o Prior administration of blood products
o Risks of illicit drug use
o Collagen disease
o Thyroid disease or diabetes
o Organ transplant (liver, kidney)
o Blunt abdominal trauma (abuse, auto accident)
o Coagulopathy
o Use of indomethacin, sodium diclofenac, or potentially teratogenic drugs during pregnancy
o Younger (35 y) maternal age
o Risk factors for sexually transmitted diseases
o Hemoglobinopathy (especially with Asian or Mediterranean ethnicity)
o Occupational exposure to infants or young children
o Pet cat
o Current or recent community epidemic of viral illness
• Family history
o Jaundice in other family members or in previous child
o Family history of twinning (specifically, monozygotic)
o Family history of genetic disorders, chromosomal abnormalities, or metabolic diseases
o Congenital malformation(s) in previous child
o Previous fetal death(s)
o Hydramnios in earlier pregnancies
o Prior hydrops fetalis
o Previous fetomaternal transfusion
o Congenital heart disease in previous child