BABIES BORN ALIVE AFTER INTRAUTERINE TRANSFUSIONS FOR SEVERE RHESUS HAEMOLYTIC DISEASE

Summary

Fifty-two babies born alive after intrauterine transfusions for severe rhesus haemolytic disease during a seven-year period are described. There was a diagnostic error in one case in which the fetus proved to be rhesus negative. Thirty fetuses (58 per cent) survived. Most of the 22 deaths occurred during the early neonatal period.

The main problems encountered at birth were severe birth asphyxia, hydrops fetalis, anaemia and hypothermia. Thirty-four of the babies were asphyxiated at birth, 24 of these required abdominal paracentesis before adequate ventilation could beachieved. Of 21 babies born in a frankly hydropic condition 6 survived. Cord haemoglobin levels of less than 10 g. per 100 ml. were found in 29 infants; the lowest value was 3·4 g. per 100 ml. Twenty-one babies became hypothermic. Undue trauma resulted from intrauterine transfusion in 9 babies, and one suffered liver injury during paracentesis after birth.

The main problems encountered during the neonatal period were those of prematurity. The most important was respiratory distress which carried a very poor prognosis, due in part to pulmonary hypoplasia in hydropic babies. Other important problems were hypoglycaemia, enterocolitis, neurological abnormalities, protracted jaundice, congestive heart failure, infections and bleeding diathesis. Of the survivors old enough to be adequately assessed, all except three have developed normally.

The implications of these findings are discussed.