Anemia of Prematurity - Portal Neonatal

• Space-occupying masses, which impair venous or lymphatic return, are among the more
important causes of fetal hydrops. Management varies depending on the type of lesion and
from center to center. However, the fundamental basis for most treatments has been reduction
or removal of the mass when immediate delivery is not practical.
o Pleural effusions have been managed with single or serial fetal thoracenteses,
pleurothoraco-amniotic shunts, and direct fetal surgical maneuvers to correct the
underlying cause(s).
o Pericardial effusions have been managed similarly with single or serial pericardiocenteses
or continuous drainage maneuvers.
o Ascites has also been treated with single or multiple taps, peritoneo-amniotic shunts, and
intraperitoneal albumin. Successes and failures have been reported with all methods; no
evidence exists that 1 approach is any better than another because proper comparative
trial data do not exist in the literature.
o Fetal surgery with definitive correction of the underlying anomaly has been reported with
increasing frequency. Improved fetal survival with cystic adenomatoid malformation and
with bronchopulmonary sequestration has been observed in several large series in which
these direct corrective measures have been employed. While this success has been
measured against outcomes using historic controls, such measures make physiologic
sense and, thus, demonstrate considerable promise.
• Resuscitation and delivery room management of hydrops fetalis pose a unique set of
problems for the neonatologist.
o Once hydrops has been diagnosed antenatally, make every effort to establish the cause;
this is helpful in treating the infant at birth.
o In addition to appropriate equipment and supplies, a skilled team of experienced health
care professionals (neonatologists, nurses, respiratory therapists, radiograph technician,
ultrasound technician) should be present in the delivery room.
o Perform or repeat antenatal ultrasound examination to assess the presence and extent of
pleural effusion, pericardial effusion, or ascites prior to delivery because the fluid may
require aspiration in the delivery room to establish adequate ventilation and circulation.
o Fetal blood assessment by percutaneous umbilical sampling, although risky, may be
helpful in selected cases for early management.
o After establishing the infant's airway and ventilation, place umbilical arterial and venous
catheters to monitor arterial pressure, blood gases, and venous pressure.
o Packed erythrocytes or whole blood crossmatched with the mother's blood should be
available for partial exchange transfusion to correct severe anemia, even when due to
nonimmune causes.
o Anticipate and promptly correct metabolic derangements such as acidosis and
hypoglycemia.
o Surfactant deficiency and hypoplastic lungs may be associated with hydrops and are
managed accordingly.
MEDICATION Section 7 of 10
The number of drugs that have been used for the correction of fetal arrhythmias reflects the amount of
uncertainty about dosage, effectiveness, and hazards. Fetal pharmacokinetic studies are not available,
and dosage schedules for these very immature infants are uncertain. Thus, consider each case
individually; the prudent physician must be aware that therapeutic misadventures remain possible if
not probable.
Drug Category: Cardiac glycosides -- These are used for fetal cardiac failure. Positive inotropic
agents (eg, digoxin) increase force of contraction of myocardium and are used to treat acute and
chronic CHF.