Abstract
Objective
This study aimed to assess short-term neurodevelopmental outcomes for neonates affected
by fetomaternal hemorrhage (FMH) and compare them with an unexposed group.
Study Design
A retrospective cohort analysis was conducted within a large integrated medical system
spanning from 2008 to 2018. Neurodevelopmental outcomes of neonatal survivors of FMH
were compared with matched controls. Clinically significant FMH in survivors was defined
by maternal flow cytometry for fetal hemoglobin result of >0.10% and neonatal transfusion
requirement. One unexposed infant was identified for each surviving FMH-exposed infant,
matched by gestational age at delivery (±1 week), birth year, sex, and race/ethnicity.
The primary outcome was a diagnosis of neurodevelopmental impairment, identified using
the International Classification of Diseases (ICD), 9th and 10th Revisions (ICD-9
and ICD-10) codes. Results were presented as proportions, means, medians, and interquartile
ranges. Comparisons were performed using chi-square and Fisher's exact tests. A Cox
proportional hazards regression model was conducted to examine associations between
cognitive and developmental outcomes and FMH exposure.
Results
Among 137 pregnancies with clinically significant FMH, 80 resulted in intrauterine
demise, 57 neonates required blood transfusion, and 4 neonates requiring transfusion
demised during birth hospitalization. No significant difference in rates of neurodevelopmental
impairment was found between FMH-exposed and unexposed infants (26.4 vs. 24.6%, p = 0.8). Similar findings were observed in preterm (37 vs. 31.6%, p = 0.7) and term neonates (15.4 vs. 14.8%, p = 1.0). Cox regression showed no significant association between neurodevelopmental
outcomes and FMH exposure (1.17 [95% CI: 0.61–2.22]; p = 0.6).
Conclusion
Despite the significant perinatal morbidity and mortality associated with FMH, surviving
infants did not show a significant difference in neurodevelopmental diagnoses compared
to matched unexposed infants. However, definitive conclusions are limited due to the
rarity of FMH requiring transfusion and the small exposed sample size, warranting
further evaluation in a larger cohort.
Key Points
FMH is associated with profound fetal and neonatal morbidity and mortality.
Impact on neurologic development for infants surviving FMH is unknown.
Neurodevelopmental outcomes did not differ between survivors of FMH compared to matched
controls.
Keywords hypoxic–ischemic encephalopathy - fetal anemia - fetomaternal hemorrhage - neonatal
acidemia - neurodevelopmental outcome - neurologic injury
