Resuscitation with Intact Placental Circulation in a Preterm Infant with Hydrops Fetalis

Abstract

A preterm infant with prenatal diagnosis of hydrops fetalis was spontaneously delivered at 30 weeks of gestational age in a tertiary level hospital. Prenatal echography pointed out severe bilateral pleural effusions and diffused subcutaneous edema. A neonatologist team, alerted at the expulsion stage of labor, assisted the neonate immediately after birth and bilateral hydrothorax was drained with intact placental circulation to avoid a nonrespiratory period and its possible detrimental hemodynamic effects. The newborn was well stabilized in the delivery room before cutting the umbilical cord and starting mechanical ventilation. Unfortunately, our patient died due to refractory respiratory failure on the fourth day of life. However, the intact placental circulation procedure was performed without adverse effects to the infant and might represent a promising option in addition to other resuscitation procedures for the management of this type of patient.

Keywords

hydrops fetalis - neonatal resuscitation - delayed cord clamping - bedside resuscitation

• References

• 1 Santo S, Mansour S, Thilaganathan B. , et al. Prenatal diagnosis of non-immune hydrops fetalis: what do we tell the parents?. Prenat Diagn 2011; 31 (02) 186-195
• 2 Ota S, Sahara J, Mabuchi A, Yamamoto R, Ishii K, Mitsuda N. Perinatal and one-year outcomes of non-immune hydrops fetalis by etiology and age at diagnosis. J Obstet Gynaecol Res 2016; 42 (04) 385-391
• 3 Bellini C, Hennekam RCM. Non-immune hydrops fetalis: a short review of etiology and pathophysiology. Am J Med Genet A 2012; 158A [phone]
• 4 Brock WW, Bradshaw WT. Congenital chylothorax: a unique presentation of nonimmune hydrops fetalis in a preterm infant. Adv Neonatal Care 2016; 16 (02) 114-123
• 5 Prontera W, Jaeggi ET, Pfizenmaier M, Tassaux D, Pfister RE. Ex utero intrapartum treatment (EXIT) of severe fetal hydrothorax. Arch Dis Child Fetal Neonatal Ed 2002; 86 (01) F58-F60
• 6 Chang YL, Lien R, Wang CJ, Chang SD, Soong YK. Congenital chylothorax in three siblings. Am J Obstet Gynecol 2005; 192 (06) 2065-2066
• 7 Henry PY, Aravindan CS, Sivakumar K, Krishna HR. Extrauterine intrapartum treatment (EXIT) in bilateral primary fetal hydrothorax. Indian J Pediatr 2009; 76 (01) 99-101
• 8 Eraslan S, Melekoglu R, Celik E. Extrauterine intrapartum treatment procedure in the unilateral advanced fetal hydrothorax case. Perinatal J 2015; 23 (01) 60-64
• 9 Wyckoff MH, Aziz K, Escobedo MB. , et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18, Suppl 2): S543-S560
• 10 Bhatt S, Alison BJ, Wallace EM. , et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013; 591 (08) 2113-2126
• 11 Hooper SB, Te Pas AB, Lang J. , et al. Cardiovascular transition at birth: a physiological sequence. Pediatr Res 2015; 77 (05) 608-614
• 12 Bhatt S, Polglase GR, Wallace EM, Te Pas AB, Hooper SB. Ventilation before umbilical cord clamping improves the physiological transition at birth. Front Pediatr 2014; 2: 113
• 13 Hooper SB, Polglase GR, Roehr CC. Cardiopulmonary changes with aeration of the newborn lung. Paediatr Respir Rev 2015; 16 (03) 147-150
• 14 Backes CH, Rivera BK, Haque U. , et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (01) 47-56
• 15 Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117 (01) 93-98