Anemia of Prematurity - Portal Neonatal

most commonly thrombocytopenia, is found in approximately the same proportion
of cases. Tumor size by sonography has not been demonstrated to be an
independent prognostic factor; however, solid, highly vascular tumors lead to
hydrops more often than those with a more cystic, less vascular structure.
o Since chromosomal abnormalities and life-threatening anomalies are rare with
sacrococcygeal sequestration, early diagnosis and aggressive fetal treatment are
particularly important with this condition. While bloody AF secondary to rupture of
the highly vascular teratoma is not uncommon, diagnosis in most cases has been
made only after hydrops has developed.
o Early routine fetal imaging may be the only way in which early diagnosis can be
made in this condition; however, the low incidence of sacrococcygeal teratoma
may preclude cost-effective screening for this condition. Elevated concentrations of
alpha-fetoprotein (AFP) and/or acetylcholinesterase in AF have been found to
accompany fetal sacrococcygeal teratoma, but the invasive sampling and low
specificity appears to preclude these tests as routine screening procedures. While
placental chorioangiomas are common (present in approximately 1% of
pregnancies), large vascular tumors with cardiovascular and hematologic
consequences are very uncommon. When present, the pathophysiology is
remarkably similar to that found with fetal sacrococcygeal teratomas. Diagnosis
and techniques for early intervention are also similar.
• Bronchopulmonary sequestration is a condition in which abnormal vascular supply and
misplacement of a portion of the lung may lead to torsion of the affected lobes, profound
obstruction of lymphatic and venous return, and tension hydrothorax. This sequence of
events leads to fetal hydrops in perhaps one third of such cases. Although drainage of the
hydrothorax, definitive diagnosis using color Doppler imaging, and fetal angiography have
been described, and though fetal surgical excision of the affected portion of the lung may
improve survival in this condition, nearly two thirds of these cases fail to be diagnosed
before fetal death or birth occurs.
• Cystic adenomatoid malformation of the lung may also lead to hydrops by mass
compression of venous return. Because this condition is seldom associated with other
malformations or with chromosomal abnormalities and because fetal surgical maneuvers
have demonstrated considerable promise with some forms of the disorder, early and
precise diagnosis using fetal imaging techniques is of critical importance. Pulmonary
capillary-alveolar development is abnormal in this condition, and 3 degrees of severity,
described initially by Stocker, have been used to predict prognosis.
o Type I: The fetus with large (>2 mm), isolated cysts seldom develops hydrops, and
spontaneous remissions have been reported. Drainage or excision of individual
cysts has also been reported with generally favorable outcomes.
o Type II: Poorer prognosis is associated in the fetus with smaller (